Epidural fibrosis is a common condition arising after back surgery where scar tissue forms near the nerve root and this may, or may not, lead to leg pain, back pain and other symptoms, depending on its severity. There are other possible reasons for leg cramps after back surgery, including simple dehydration and potassium imbalance, so if such symptoms arise it is important to uncover their cause.
Will Leg Cramps After Back Surgery Be Permanent?
Many patients undergo back surgery to address leg pain and back pain resulting from spinal stenosis. The occurrence of leg cramps and pain after back surgery may be due to residual nerve damage as not all patients experience immediate relief following surgery. Where pain persists after a reasonable healing time, a thorough physical examination and diagnostic imaging can often help identify the cause of the pain. In some cases this may be a result of the wrong vertebral level being operated on and the actual cause of pain remaining unaddressed. Leg pain and back pain that occur weeks or months after back surgery will often be a result of recurrent disc herniation or an additional spine problem that was not addressed by surgery.
Some things to consider as possible causes of leg cramps after back surgery include:
- Magnesium deficiency
- Potassium/sodium imbalance
- Varicose veins or vascular claudication
- Neurogenic claudication or other nerve issue
- Epidural fibrosis
- Undiagnosed spinal stenosis
- Side-effects of medications
- New orthopaedic shoes worn during recovery
- Alcohol consumption
Scarring After Back Surgery
Scar tissue itself is rarely painful as this tissue does not contain nerve endings. However, it can bind to, or around nerves and lead to leg cramps, leg pain and back pain. Typically, symptoms of scarring will arise six to twelve weeks after back surgery, preceded by a period of pain relief. There are ways to minimize the risks of scarring and fibrous nerve adhesion after back surgery, including appropriate stretches and physical therapy, ceasing smoking before surgery and ensuring proper nutrition and hydration.
Mineral Imbalances and Leg Cramps
Where severe and persistent leg cramps occur after back surgery it is important that patients discuss their symptoms with their physician. Metabolic testing may be carried out to ensure that potassium and sodium balance is good as a lack of potassium can lead to muscle cramps. Magnesium deficiency can also make it difficult for the muscles to relax after being constricted and so some patients find that leg cramps are more common after experiencing stress, such as surgery or as a result of some medications that or supplements that affect magnesium absorption or excretion. High dose calcium supplements can be a cause of magnesium imbalance and leg cramps and some patients find that a combination supplement, alongside vitamin D, is a better option when recovering from spinal fusion or other type of bone-related surgery.
Nerves and Leg Cramps
Persistent leg cramps after back surgery could be a sign of partial nerve damage and intermittent nerve firing that leads to spasms in the muscles and eventual fatigue or cramp. An electromyelogram (EMG) and/or nerve conduction velocity (NCV) study could help elucidate the nature of the leg pain and cramps after surgery. It may be that such tests uncover a nerve problem in addition to the spine problem that led to back surgery. Seeing a physiatrist who specializes in neuromuscular dysfunction is often helpful in identifying the cause of leg cramps after back surgery.
Circulation and Leg Cramps
Another possible cause of leg cramps after back surgery is a circulatory issue that may have been triggered by the experience of surgery. Deep vein thrombosis can arise when a patient undergoes any surgical procedure, particularly when general anaesthesia is used and the operation takes several hours. Blood clots that form in the veins in the legs may create ischaemia and resulting muscle spasms and cramps as the tissue is deprived of oxygen. These clots have the potential to cause serious tissue damage and even prove fatal if they detach and travel to the heart or brain and block blood flow at such sites.
Varicose Veins and Leg Cramps
Varicose veins are also a potential cause of leg cramps after back surgery as a patient may require bed rest or limited activity during recovery and blood that pools in the lower limbs when sitting the begins to circulate again upon laying down in bed at night. These kind of night cramps may be avoided by remaining active during the day, performing simple leg stretching exercises to keep the blood flowing. Elevating the legs at regular intervals may also help, as can compression stockings.
Sleep, Leg Cramps and Back Surgery
Using a special back pain pillow can help relieve nerve pressure and ischaemia in some cases and may aid sleep after back surgery. Those who sleep on their back often find that leg cramps and pain are relieved or avoided by placing a pillow beneath their knees to flatten out the back. Side-sleepers can place a pillow between their knees to keep the spaces in the spine open during sleep and thus minimize nerve compression. Some people also find that an acupressure mat can help to relieve leg cramps as this can encourage healthy circulation in the lower limbs.
Diagnosing Leg Cramps After Back Surgery
Ruling out nerve compression or spinal instability after back surgery is the first challenge for physicians helping those suffering from leg cramps and/or pain, numbness and tingling. Patients may be prescribed antispasmodic medications to help with leg cramps during the diagnostic process. Not all leg cramps after back surgery are due to scar tissue or a permanent problem but it can take time to work out the cause of the condition.