Bowel constipation after spinal surgery

[Keano16]

Hello, recently patient came after spinal fusion at L3-L4.
Unwanted result of this surgery is chronic bowel constipation for past 9 months.

Laxatives do not help. Neither any of natural remedies.

Lower extremities EMG, sphincter EMG, X-Ray, MRI and CAT do not show abnormalities which could affect bowel.

Any advices what do to with patient?

Anyone heard about hypogastric plexus stimulation?

Regards

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[typhoonegator]

Is the patient on opiate analgesics for the back pain surrounding this fusion? Is the patient on any other medications that could provoke constipation?

Have you considered a trial dose of PO naloxone? It can be effective in stimulating gut motility even in patients not on opiates (blockade of endogenous opioid receptor agonists). Not a great long term solution, but good for a test.

The enteric nervous system works even in the absence of descending influence from the spinal cord. People with complete transection of the cord still have bowel movements with the assistance of stool softeners, laxatives, and digital stimulation. It sounds like your patient only possibly has root disease at one level. Perhaps you need to break out the big guns.

 

[Keano16]

Thanks on your reply.

We will check colon with gastroenterologists to exclude it as possible problem.

Naloxone is worth trying, we will consider it.

I am not sure if I understand this part, can you clarify please:

It sounds like your patient only possibly has root disease at one level

 

[typhoonegator]

Your patient had an L3-4 fusion. Assuming no severe canal stenosis, only the roots exiting at L3-4 should be affected (although in some circumstances, the roots from the above segment can be affected by disk extrusion). Patients have this surgery all the time, and even with severe root impingement pre-op, you don't commonly see severe refractory constipation *attributable to the roots*. You often do see it in this population due to opioids, sedentary lifestyle due to pain, etc. Is the thyroid function OK?

 

[Keano16]

Hello,

there was no canal stenosis prior to surgery, and there is no canal stenosis now.
MRI shows good screw placement. Maybe a little nerve root irritation of left L4 nerve root, patient experiences only minor leg pain from time to time, this does not affect her daily activities and we don't think this is an important problem.

Thyroid is OK!

Thanks for your participation in this case.