OpenHealth Q&A

Persistent Lower Back Pain Following Bertolotti's Resection Surgery

I’m a 35-year-old woman who received a diagnosis of Bertolotti's syndrome type 1B last November. In January of this year, I chose to undergo a minimally invasive resection surgery performed by a neurosurgeon renowned for his expertise in adult spinal deformities. Despite the surgery, I continue to experience discomfort in my lower back months later. My neurosurgeon initially assured me that I would return to my normal state within two weeks post-surgery, but that hasn’t been the case. The sensations I have are quite unusual; I often feel an itchy, crawling sensation that extends from my mid-back down to the top of my buttocks. Since March, I have been attending physical therapy sessions twice a week to address this discomfort. A follow-up MRI was carried out, and both my neurosurgeon and a physiatrist reviewed the results, indicating that everything appears to be normal. I possess the MRI details and will share them for reference. It’s important to note that I had three prior disc herniations, which have not shown to impact my condition. Here is a summary of the MRI findings: FINDINGS: - The vertebral bodies maintain their height and alignment. - There are minimal degenerative changes noted at the L5-S1 endplate. - Multilevel disc desiccation is present while maintaining disc height; a very small endplate Schmorl's node may be found at the inferior aspect of L5. - The conus is normal and unremarkable. - No suspicious collections of epidural fluid are observed. - The report indicates status post partial resection of the transverse processes at L5 and sacral ala at S1 on both sides. Edema is noted beneath the posterior elements at L5 and S1, affecting the posterior lumbar muscles and interspinous space, and these changes are bilateral. Additionally, there is a symmetric linear T2 hyperintensity at the subcutaneous soft tissues of the lumbar area near L5, which appears new compared to my last MRI from October 27, 2024, likely indicating postoperative changes. In the axial images through the disc spaces: - At T12-L1, L1-L2, and L2-L3, no significant disc herniation, spinal canal stenosis, or foraminal narrowing is observable. - At L3-L4, a disc bulge with a central disc protrusion is present, resulting in slight indentation on the thecal sac, but without significant canal stenosis. - At L3-L4, a concentric bulge accompanied by an annular fissure is noted, along with very mild indentations on the thecal sac, but again, no major stenosis or narrowing is seen. - Mild facet arthropathy can be observed. - At L5-S1, there is a broad-based disc protrusion that leans slightly to the left, with no signs of serious canal stenosis or foraminal narrowing. No signs of abnormal widening are observed at the sacroiliac joints, which otherwise appear normal. IMPRESSION: - There is notably a partial resection of the L5 transverse process and S1 sacral ala on both sides, with related changes post-surgery. Mild edema and inflammation are fairly symmetric around the surgical area. - Mild degenerative disc disease and facet arthropathy are identified in the lumbar region, with no evidence of serious stenosis. I am seeking insights regarding the mild edema and inflammation. Specifically, I would like to determine whether these symptoms are muscle-related, subcutaneous tissue-related, or both. Any expert suggestions or advice would be greatly appreciated!

Answers (1)

6/23/2025, 9:11:08 PM

OpenHealth AI

It sounds like you're going through a challenging time with your recovery from the Bertolotti's resection surgery. The persistence of your lower back pain and the unusual sensations you're experiencing can be quite concerning, especially considering your active efforts in physical therapy and the insights from your recent MRI.

Main Points:

1. The mild edema and inflammation noted in your MRI could be related to tissue healing post-surgery, possibly affecting both muscle and subcutaneous tissue.
2. Persistent symptoms like yours are not uncommon after spinal surgery and can result from a variety of factors, including residual inflammation and muscle tension.

Explanation:

The edema (swelling) and inflammation in the area post-surgery might be your body's natural response as it heals. This can be influenced by muscular tension around the surgical site, residual inflammation from the surgery, or even nerve-related sensations. The itching and crawling feelings you've described may suggest nerve irritation or sensitivity in the surrounding tissues, often referred to as neuropathic symptoms.

The MRI shows that although there are no major structural problems, the presence of mild edema indicates ongoing healing. Healing in this area can take several months, and the sensations you're feeling could be part of that process.

Next Steps:

1. Continue Physical Therapy: Maintaining your physical therapy sessions is essential. Discuss your symptoms with your therapist—they may modify your exercises to help address the specific sensations and pain you're experiencing. Focus on gentle stretching and strengthening exercises designed for post-surgical recovery.

2. Manage Inflammation: You might consider incorporating ice therapy on your lower back after physical therapy sessions to help with swelling. Apply ice wrapped in a cloth for 15-20 minutes to avoid skin irritation.

3. Gentle Mobility: Engage in gentle mobility exercises like walking or swimming, which can promote blood flow and reduce stiffness without placing too much strain on your back.

4. Symptom Tracking: Keep a diary of your symptoms, including when they occur, their intensity, and any activities that seem to aggravate or relieve them. This can be informative for your healthcare providers as you progress.

5. Follow Up: Schedule a follow-up with your neurosurgeon or physiotherapist to discuss your ongoing symptoms and any adjustments in your treatment plan. They can evaluate your healing progress and consider other options if your symptoms do not improve.

Remember, healing from surgery can be a gradual process, and it's important to remain patient with yourself during this time. If you experience any new symptoms or if your current symptoms worsen, make sure to reach out to your healthcare provider promptly. You're doing a great job advocating for your health—keep it up!