Foot Drop Post Laminectomy

40 yo male professional athlete suffered an L4-5 disk herniation to the right and lumbar stenosis at the same level. He underwent a decompressive laminectomy and BAK cage and pedicle screw fixation fusion.  Multiple disk fragments were noted under the L5 nerve root including below the axilla of the L5 root between the common dural sac and the axilla below the disc space almost to the level of the superior margin of the L5-S1. The MD confirmed the herniation originated at the L4 disc and not the L5-S1. The nerve root was intact.

Following surgery client suffered from L foot drop which persisted 16 months post surgery. Although the surgical report notes pre-existing foot drop, the patient denied same and was given the Dr’s phone number with instructions to call should he develop any foot drop symptoms presurgery. The condition is permanent with a less than 1% chance of improvement. A subsequent treating MDs advised my client that the surgeon “stretched the nerve to far” causing permanent damage.

MEDQUEST EXPERT RESPONSES:

Surgical decompression of the L5 nerve root has been long known to be complicated with a post operative increase in the weakness of the ankle leading to a foot drop. This is due to manipulation of the nerve root beyond its tolerance. However, this is not avoidable in all patients even in the best of hands. It is an unfortunate well known complication and does not by itself mean there was a breach in the standard of care.Dr SB – Neurosurgeon

Foot drop is a risk of this operation. I do not have a serious doubt that it is the result of stretch injury from the surgery, but this does not automatically amount to a deviation from the standard of care. Some factors exist that would begin to cast doubt upon the adequacy of the technique ie if an inappropriately large graft was put in (leading to too much nerve stretch) or severe malposition of the hardware. Viewing of the films and records would resolve the issue.
Dr JH – Neurosurgeon