[AnneSmith]

#22162

In January 2016 I had a Scoliosis revision surgery. I am 50 years old. I had a L3-S1 fusion with Illiac fixation and a T10 to L3 re-instrumentation. This was done ALL Posterior, and was done to correct the Flatback that had developed under my existing long fusion. I woke up with Foot Drop in my left foot. I’m four months out with little improvement – I can move my toes an increment but that’s it. An X ray and MRI after the surgery revealed no abnormalities. Question: What type of imaging does one need to see the Pedicle screws? I know of a Scoliosis surgery patient like myself who’s Foot Drop was only corrected after a second surgeon did a CT Scan and later removed a screw that was poling through a nerve. Do I need to be asking for a CT scan to rule this out? Please advise. Thank you,

[Donald Corenman, MD, DC]

#22175

If you have a loss of function of a nerve root after a surgery, a new scan should be performed to determine the cause. Find out if the surgery had neuromonitoring (the monitoring of nerve roots as the surgery progresses by a technician in the room at the time of surgery). It is true that screw placement can occasionally cause nerve malfunction.

In addition, in a scoliosis surgery, the vertebra are being “straightened out” or stretched back to a more appropriate alignment. The nerve root also become stretched depending upon the degree of correction. Occasionally, a stretch of a nerve root can cause dysfunction.

Foot drop is normally caused by injury to the L4 or L5 nerve root. If the EHL (extensor hallicus longus-great toe extensor or “lifter”) is also weak, this would be an L5 nerve root. If the EHL is not weak, it would be L4. An EMG test might also be helpful. See https://neckandback.com/treatments/emgncv-electromyograms-and-nerve-conduction-studies/.

I would recommend starting with an MRI and possibly a CT scan along with a good physical examination.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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