Differential Diagnosis for Unilateral Leg Swelling after Lumbar Spinal Surgery (TLIF)
Single Most Likely Diagnosis
- Deep Vein Thrombosis (DVT): This is the most likely diagnosis due to the patient's recent history of surgery, which increases the risk of blood clots. Immobility during and after surgery further elevates this risk. Unilateral leg swelling is a classic presentation of DVT.
Other Likely Diagnoses
- Lymphedema: Although less common, lymphedema can occur after surgery, especially if there was damage to lymphatic vessels during the procedure. It typically presents with swelling, but the onset might be delayed.
- Cellulitis or Soft Tissue Infection: Infection can cause unilateral leg swelling, especially if the infection is localized to the soft tissues. Recent surgery increases the risk of infection.
- Hematoma: A collection of blood outside of blood vessels can cause swelling and is a possible complication of surgery.
Do Not Miss Diagnoses
- Pulmonary Embolism (PE) with DVT: Although DVT is the most likely diagnosis, it's crucial not to miss the possibility of a pulmonary embolism, especially if the patient presents with respiratory symptoms. PE can be fatal if not promptly treated.
- Compartment Syndrome: This is a medical emergency that can occur after surgery, especially if there is increased pressure within the muscle compartments of the leg. It requires immediate intervention to prevent permanent damage.
- Arterial Occlusion: Although less common, arterial occlusion can cause acute limb ischemia, which is a medical emergency. It might present with the "6 Ps": pain, pallor, pulselessness, poikilothermia, paresthesia, and paralysis.
Rare Diagnoses
- Nerve Root Injury or Cauda Equina Syndrome: These conditions can cause swelling, but they are more commonly associated with neurological deficits such as weakness, numbness, or changes in bladder and bowel function.
- Allergic Reaction: An allergic reaction to medications or materials used during surgery could potentially cause swelling, although this would be less common and might be accompanied by other systemic symptoms.
- Venous Insufficiency: Pre-existing venous insufficiency could be exacerbated by surgery, leading to swelling. However, this would typically be a more chronic condition rather than an acute presentation post-surgery.