From the Guidelines
The appropriate workup for post-operative back pain and numbness/tingling in the legs after a spinal injection for anesthesia should begin with a thorough neurological examination and laboratory tests to evaluate for infection, as well as urgent MRI of the spine if concerning symptoms are present. The workup should include:
- A thorough neurological examination to assess the distribution and severity of symptoms, including evaluation of motor strength, sensory function, reflexes, and straight leg raise testing
- Laboratory tests such as complete blood count, C-reactive protein, and erythrocyte sedimentation rate to evaluate for infection, as abnormal laboratory parameters may increase the clinical suspicion for spine infection in the postintervention patient 1
- Urgent MRI of the spine if there are concerning symptoms such as progressive neurological deficits, bowel/bladder dysfunction, or severe pain unresponsive to conservative measures, as these may indicate serious complications like epidural hematoma or abscess requiring immediate intervention
- Initial management typically involves pain control with acetaminophen and NSAIDs like ibuprofen if not contraindicated, and physical therapy should be initiated once acute pain improves
- The timing of the imaging examination is particularly important, as expected findings such as alteration of soft tissue and osseous structures, edema, and small paraspinal fluid collections may represent the normal sequelae of an intervention shortly after the procedure 1
- If symptoms worsen or fail to improve within 1-2 weeks, referral to a neurologist or spine specialist is warranted for further evaluation, as the diagnosis of postintervention spine infection is a clinical challenge given an overlap of clinical symptoms between postoperative and spine infection patients 1
From the Research
Post-Operative Back Pain and Numbness/Tingling in Legs after Spinal Injection for Anesthesia
Workup
The workup for post-operative back pain and numbness/tingling in the legs after a spinal injection for anesthesia may involve the following:
- Evaluating the patient's symptoms and medical history to determine the cause of the pain and numbness/tingling 2
- Conducting a thorough physical examination to assess the patient's neurological function and identify any potential causes of the pain and numbness/tingling 2
- Ordering imaging studies, such as MRI or CT scans, to rule out any structural causes of the pain and numbness/tingling, such as a herniated disk or spinal stenosis 3
- Performing electromyography (EMG) and nerve conduction studies to assess the function of the nerves in the legs and identify any potential causes of the numbness/tingling 4, 5
- Considering the possibility of postsurgical inflammatory neuropathy, a condition that can cause nerve pain and numbness/tingling after surgery, and treating it with corticosteroids if necessary 2
- Evaluating the patient for other potential causes of the pain and numbness/tingling, such as deep vein thrombosis (DVT) or pulmonary embolism, and treating them accordingly 3
Potential Causes
Some potential causes of post-operative back pain and numbness/tingling in the legs after a spinal injection for anesthesia include:
- Transient radicular irritation (TRI), a condition that can cause pain and numbness/tingling in the legs after spinal anesthesia 4
- Postsurgical inflammatory neuropathy, a condition that can cause nerve pain and numbness/tingling after surgery 2
- Nerve damage or compression, which can cause numbness/tingling and pain in the legs 2
- Deep vein thrombosis (DVT) or pulmonary embolism, which can cause pain and numbness/tingling in the legs 3
- Failed back surgery syndrome (FBSS), a condition that can cause chronic pain and numbness/tingling in the legs after spinal surgery 6