Case Of Foot Drop Research Articles

A new management strategy in reopening laminectomies for cases with spinal canal stenosis

Background While a laminectomy is often mandated for spinal canal stenosis, foraminal stenosis may account for pain and functional limitations instead of central canal issues. Targeted treatment directed at this specific region may enhance patient outcomes. Methods Retrospective observational study of a total of 30 patients with previous decompression laminectomies for lumbar spinal canal stenosis were operated upon for foraminotomies from November 2012 to November 2018. The surgeries were clinically done, and EMG-confirmed nerve root compressions were treated with exact decompression techniques according to the anatomy and pathology in each case. Additionally, a systematic review followed PRISMA guidelines was conducted, utilizing Scopus and PubMed databases to identify studies on reoperation rates after decompression with or without fusion in lumbar spinal stenosis. Results The results were fearsome post-operatively, trying significant improvement in pain, functional status, and walking distance. Pain reduction was achieved in 80% of patients by an increase in the Carnovsky rating scale with evidence of improved pain reduction and walking endurance; this points to minimal resulting complications of one complete case of foot drop and three infective cases managed conservatively. It was shown in the systematic review that fusion surgeries lowered the rates of reoperations at the index level but increased those for adjacent segment reoperations, while decompression alone had higher index-level reoperation rates due to recurrent stenosis. Conclusion Most of the emphasis on foraminal stenosis, rather than traditional laminectomies, significantly reduces postoperative pain and improves functional outcomes. This strategy brings a promising alternative to the management of recurrent symptoms in patients with lumbar spinal canal stenosis.

Foot drop on the opposite side after spinal anesthesia for ankle fracture surgery: a case report

Neurological complications after spinal anesthesia have been rarely reported. Persistent neurological dysfunction due to spinal cord or nerve root injury is a serious complication of lumbar anesthesia and manifests as leg pain, numbness, and weakness after initial recovery from anesthesia. We herein report a case of foot drop on the opposite side after spinal anesthesia for ankle fracture surgery. The patient’s symptoms completely disappeared after 3 months, and we consider that her neurological complications were likely caused by the neurotoxicity of local anesthetics.

A Single Approach for Management of Fractures Involving Both Columns of the Acetabulum: A Case Series of 23 Patients

Aim and objectiveTo study the radiological and functional outcomes as well as complications in the management of fractures involving both columns of the acetabulum using a single surgical approach.DesignType IV, prospective clinical study.SettingLevel I trauma centre.Materials and methodsInclusion criteria were as follows: (a) patients over 20 year of age and (b) patients suffering from acetabular fractures involving both columns as per Letournel and Judet classification, namely transverse, transverse + posterior wall, T type, anterior column posterior hemi-transverse (ACPHT) and associated both columns. Exclusion criteria were as follows: (a) patient suffering from isolated anterior column, posterior column, anterior wall, posterior wall and posterior wall + column fractures; (b) patient who have undergone surgical procedures of the hip prior to trauma; and (c) compound acetabular fractures. A total of 23 patients having both column acetabulum fractures were included prospectively from June 2016 to December 2018 and followed up till 1 year postoperatively. Open reduction and internal fixation were performed through one of three described approaches, i.e., iliofemoral, Kocher-Langenbeck, and anterior intrapelvic or ilioinguinal.ResultsOur study population consisted of 30.4% transverse, 39.1% associated both columns, 21.7% T type and 8.7% anterior column + posterior hemi-transverse. Of these, 65.2% were operated using the Kocher-Langenbeck approach, while 30.4% of patients required the anterior intrapelvic approach. The remaining 4.3% of patients were operated by the iliofemoral approach. Anatomic reduction was achieved in 100% of our study population with remaining displacement less than or equal to 1°mm. At 1-year follow-up, all fractures showed a satisfactory union with an excellent Matta index in 100% study subjects. Complications at 1 year included one case of foot drop, which was present preoperatively but failed to improve and one case of post-traumatic arthritis. Average Harris Hip score (HHS) and mean Merle D'Aubigne (MDA) scores suggested good clinical outcomes in the study population.ConclusionsA single approach can be used to achieve good functional and radiological outcomes in carefully selected bicolumnar fractures of the acetabulum, with less approach-related morbidity.Clinical significanceTraditionally, multiple approaches are used for acetabulum fractures involving both columns, but with proper patient selection, single approach can be used with good functional and surgical outcomes.How to cite this articlePatil A, Attarde DS, Haphiz A, et al. A Single Approach for Management of Fractures Involving Both Columns of the Acetabulum: A Case Series of 23 Patients. Strategies Trauma Limb Reconstr 2021;16(3):152–160.

Tendon transfer for dysfunction of all tendons in leg excepting Achilles tendon and plantaris tendon following irreparable sciatic nerve palsy – A case report

Introduction and importanceIrreparable sciatic nerve palsy is a cause of foot drop and resulting in absent or weak most of the muscles in leg. There may be dysfunctions of all tendons in the leg excepting Achilles tendon and plantaris tendon. The treatment of this atypical neurologic injury has not been defined.Case presentationI reported a case of foot drop following irreparable sciatic nerve palsy in which there was a dysfunction of all tendons in leg excepting Achilles tendon and plantaris tendon. The medial gastrocnemius tendon and plantaris tendon were transferred into the anterior tibialis tendon, the extensor digitorum longus tendon and extensor hallucis longus tendon. The lateral gastrocnemius tendon was transferred into the peroneus brevis. Four months post-operative, he reported no pain and became capable of walking without the assistance of an orthosis or a crutch and without steppage gait.Clinical discussionAnterior transfer of the tibialis posterior tendon was the preferred procedure. If no posterior tibial tendon function was presented, then in order of preference, the extensor hallucis longus, extensor digitorum longus, peroneal, flexor hallucis longus tendon, medial gastrocnemius, lateral gastrocnemius and plantaris tendon would be used.ConclusionThe atypical dysfunction of all tendons in the leg excepting Achilles tendon and plantaris tendon following irreparable sciatic nerve palsy was presented. Tendon transfer using medial gastrocnemius tendon, lateral gastrocnemius tendon and plantaris tendon seemed to be a good choice for treatment of this injury. It allowed reconstruction of a stable, painless, plantigrade foot.Level of evidenceCase report.

An Unusual Case of Footdrop: Bilateral Common Peroneal Nerve Palsy by One Bullet Gunshot Injury

An Unusual Case of Footdrop: Bilateral Common Peroneal Nerve Palsy by One Bullet Gunshot Injury

Case Series: Management of Foot Drop

Aim: To highlight the functional outcome of surgical management of foot drop in patients with Hansen disease.
 Case Presentation: We present three cases of foot drop following Hansen’s disease that were managed surgically by Tibialis posterior transfer. The patients had preoperative physiotherapy for ten days and postoperative physiotherapy for four weeks. Their post-operative periods were uneventful and the corrections were satisfactory.
 Discussion: Involvement of common peroneal nerve in Hansen’s disease usually results in paralysis of the anterior tibial and/or peroneal muscles. Hansen’s disease patients with foot-drop walk with a ‘high-stepping gait’, lifting the leg high as if climbing steps even while walking on level ground. When the paralysis has been present for more than six months to one year without recovery, the best option of treatment at this stage is corrective surgery and the main aim of the corrective surgery is to restore active dorsiflexion of the foot so that the gait becomes normal. This is achieved by re-routing the tendon of Tibialis posterior muscle, brings that tendon to lie in front of the ankle and is anchored distally. If the tendo-achillis tendon is found to be tight, it should be lengthened as the first step of the Tibialis posterior transfer operation.
 Conclusion: Surgical correction of foot drop usually leads to restoration of active dorsiflexion of the foot thereby preventing development of secondary deformities and ulceration. Our patients were able to dorsiflex their feet after the surgical correction.

Modeling of a biped robot for investigating foot drop using MATLAB/Simulink

This study explores an alternative approach to the study and investigation of foot drop (weakness of the dorsiflexion muscles of the foot) problem which currently being treated by ankle foot orthosis, functional electrical stimulations, and rehabilitation exercises. This problem occurs due to various reasons, such as a nerve injury. The foot drop issue leads to the inability to lift the front part of the foot and thence it causes the toes to be dragged while walking. This study provides a model of a biped robot which can simulate human cases of foot drop geared towards improving its treatment. The model of the biped robot is described along with tools necessary for simulating contact with the ground and generating gait data using a simulated robot. Specifically and as a contribution of this study, a unique representation of the foot segment (ankle and toe joints) with a foot-drop has been simulated. A conventional feedback controller is used to correct the simulated case of foot drop. The process of setting up the controller parameters, depending on the type of foot drop, is documented, and the broad strategy for solving various foot drop cases is illustrated. The results from considering a study case of a foot-drop problem are represented and discussed that show the capability of this proposed model to simulated and correct the assigned foot-drop issue into the ankle joint. The overarching goal of this study is to produce the required torque data that will be converted into muscle signals to treat real foot drop cases.

A Case of Foot Drop and Linear Erythematous Plaques

From the Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India. Correspondence to: Tarun Narang, MD, Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India. E-mail: [email protected]. The authors have no conflicts of interest to disclose.

A survey on foot drop and functional electrical stimulation

The weakness of the lower leg muscles due to nerve damage or muscle weakness can result in foot drop, a change in gait that manifests as an inability to lift the toes of the foot when walking. Foot drop results in a decreased quality of life, with unassisted movement becoming difficult or impossible. The increased risk of falls is particularly problematic as foot drop often affects the elderly or infirm for whom falling already presents a great danger. Current treatment options include fixed ankle–foot orthosis (AFO) aiming to provide rigid support to the foot if the impairment is mild or surgical intervention and functional electrical stimulation (FES) devices if the weakness is more severe. FES intervention is effective for providing a non-invasive treatment in even severe cases of foot drop. Limitations of current models relate to the non-naturalistic recreation of gait in the affected leg and its unsuitability for patients with extensive peripheral nerve damage. Although there are attempts to enhance integration of sensory information and mimic natural stimulation patterns, the focus on restoring a natural feedback loop is still amiss. Without such a closed loop feedback, restoration of a natural gait pattern is unlikely to occur. We here recommend, integration of motor output from multiple muscles, information about the inputs from higher-order controllers, recorded from the intact leg with a closed loop system to improve the effectiveness of FES.

Functional evaluation of early tendon transfer for foot drop.

Early tendon transfer has shown good outcomes in peripheral nerve injuries of upper limb. However, there is lack of knowledge on early tendon transfer for peripheral nerve palsy in lower limb. This study has been designed to study the functional outcomes of early tendon transfer in the lower limb, particularly for foot drop. We enrolled 30 cases of foot drop due to traumatic sciatic/common peroneal nerve (CPN) palsy between September 2012 and March 2016. We performed nerve exploration with repair and early tendon transfer in all patients. All patients were followed up for a minimum period of 24 months. Functional evaluation was carried out using Stanmore assessment questionnaire. At the end of 24 months postoperatively, the Stanmore assessment questionnaire score showed a significant improvement from a mean preoperative score of 17.5 to mean postoperative score of 86.2. All patients were free of ankle-foot orthosis (AFO). All patients were subjectively satisfied. Time to return to original job was 5.2 months on an average. Ankle dorsiflexion of the operated limb was comparable to the normal limb in cases where there was nerve recovery. Planovalgus foot, a known complication of this procedure, was noted in 24 patients. However, it was not disabling to any patient. Early tendon transfer in CPN palsy/sciatic nerve palsy has a definite place in the management of the injured patient. The transfer, if appropriately carried out, acts as a helper, an internal splint, a substitute, or perhaps all of the three at varying times in the rehabilitative phase of the patient. Dorsiflexor clearance in swing phase of locomotion was quickly restored in all patients, obviating the need for AFO.

The Common Peroneal (High Fibular) Nerve Block

Category: Ankle Introduction/Purpose: The bifurcation of the sciatic nerve results in the common peroneal nerve, along with the tibial nerve. A commonly block used before foot and ankle surgery is the sciatic block. This block requires an ultrasound or neurostimulation for accurate placement and can take time to administer effectively. We believe that the common peroneal, or high fibular nerve block, may be equivalent in some clinical circumstances to the sciatic block and does not require additional imaging for accurate placement. Methods: In this study, a mixture comprised of 5 mL 0.5% bupivacaine and 5 mL 1% lidocaine was used for each patient. Certain surface anatomic landmarks were used to place the block without ultrasound or neurostimulation. The time spent administering the block was recorded. Patients were not given pain medicines in the recovery unit unless the block did not work. A follow-up questionnaire was completed within 24 hours following surgery, and this was used to assess aspects of the patient’s post-operative experience. These include the number of hours following surgery that the patient: 1) first felt pain, 2) first took pain medication, 3) first felt tingling, 4) fully regained feeling in his/her leg, and 5) could wiggle his/her toes. Also, any complications were recorded. Results: This study involved 21 patients with an average age of 51. The most common procedures used with the block were hardware removal of the fibula and open reduction internal fixation of the fibula. The block took on average less than 3 minutes to administer and ultrasound was not used in any cases. No patients were given pain medicines in the recovery unit. None of the patients reported any complications, specifically, there were no cases of foot drop or any persistent paresthesias. The average time it took for patients to first feel pain after the block was approximately 8 hours. On average, patients first took pain medication approximately 11 hours after surgery, and regained sensation in their leg 15 hours after surgery. Conclusion: The benefits of the common peroneal block are multifold, as their clinical outcomes were positive and patients did not experience any complications. Also, from a surgeon perspective, the block is quick to administer and does not require ultrasound or neurostimulation.

Intramedullary Nailing of Subtrochanteric Fractures: Our Experience

ABSTRACT Aim To study clinicoradiological outcome of subtrochanteric femur fractures following intramedullary nailing. Materials and methods This was a prospective study of 22 cases of subtrochanteric fractures admitted and operated by intramedullary nailing at Southern Railway HQ Hospital, Chennai, between June 1, 2017, and May 31, 2018. Results The mean age distribution was 65.09 ± 17.84 years with 12 females and 10 males. According to Seinsheimer classification, there were six cases of type II, seven cases of type III, three cases of type IV, and six cases of type V. Intraoperative reduction techniques included closed reduction in 25% of subjects, limited open reduction in 50% and open reduction, augmentation with cerclage wiring in remaining 25%. Radiographic examination using radiological union score of hip (RUSH) was done to evaluate fracture union at monthly follow-up. Our mean time for union was 13.86 ± 3.8 weeks. Functional recovery was evaluated by the Harris hip scoring (HHS) system at 1, 3, 6, and 12 months postoperatively. The mean HHS at 6 months and 12 months were 81.57 ± 12.39 and 87.33 ± 8.2, respectively. Excellent to good functional outcome was seen in 76% of cases. There were two patients with superficial infections, one case of foot drop, and another case of lag screw cut-out. The mean shortening noted at final follow-up was 1.548 ± 0.57 cm. Conclusion An intramedullary nail is an efficient device for the treatment of subtrochanteric fractures with high rate of bony union provided optimal reduction of the fracture and good positioning of the nail and screws is achieved. How to cite this article Basani V, Kumar MR, Dhanalakshmi D, et al. Intramedullary Nailing of Subtrochanteric Fractures: Our Experience. J Orth Joint Surg 2019;1(1):15–21.

An unusual neurological complication following internal fixation of pertrochanteric fracture neck of the femur.

Fracture of the femoral neck is a common injury in the elderly population and may be associated with significant morbidity. More than 25,000 patients per year in the UK receive treatment for femoral neck fractures. Neurological injury associated with pertrochanteric fracture of the neck of the femur is rare. Sciatic nerve injury following isolated pertrochanteric femoral neck fractures is very rare and has not previously been reported in the literature. We describe a case of foot drop secondary to sciatic nerve injury following fracture of neck of the femur, with recovery after surgical exploration and nerve release. (Hip International 2002; 4: 400-2).

Comparative study of functional outcome of cemented and uncemented total hip replacement

Background: To compare functional outcome of cemented and uncemented total hip replacement (THR). Materials and Methods: In this hospital based, randomized, comparative type of observational study, 25 patients were included in each group. Each patient examined thoroughly and underwent radiological assessment. Follow-up done at 6 weeks, 3 months, 6 months, and 2 years and pain score, Harris Hip Score (HHS), subjective complaints, and joint stability were recorded. Results: Mean age of the patient in cemented group was 60.64 years and in uncemented group was 59.72 years. Pain score was compared at each follow-up which came out significant at 6 weeks (P ≤ 0.05) and 3 months (P = 0.002) explaining better early bone integration with cemented THR. However, at 6 months difference in pain score between two groups was nonsignificant (P = 0.176). Difference in function score between cemented and uncemented group was significant at 6 weeks (P = 0.003) and 3 months (P ≤ 0.05) which later become nonsignificant at 6 months (P = 0.38). The difference of HHS between cemented and uncemented group was significant at 6 weeks (P ≤ 0.05) and 3 months (P = 0.011). This difference became nonsignificant at 6 months. HHS is further divided into four grading – poor (<70), fair (70–79), good (80–89), and excellent (90–100). Overall in our study, 88% of patients in cemented group showed excellent and good results and 84% in uncemented group showed excellent and good results. There was one case of excessive blood loss during surgery in uncemented group and one case of foot drop in cemented group. Conclusion: Cemented implants are cheaper than the uncemented implants. Better short-term clinical outcomes mainly improved pain and early pain-free full weight bearing was obtained from cemented fixation.

Comparison of the Effects of Epidural Anesthesia and Local Anesthesia in Lumbar Transforaminal Endoscopic Surgery

Background: Percutaneous endoscopic lumbar discectomy (PELD) is a standard technique for the treatment of lumbar disc hernia. Thus far, most surgeons have recommended local anesthesia. However, in clinical practice, some patients experience pain and are unable to cooperate with the surgery during intervertebral foramen hemp expansion. The use of general anesthesia may create a greater risk of complications because of nerve root anomalies; thus, intraoperative neurophysiological monitoring should be utilized. Reports regarding the use of epidural anesthesia are few in comparison. Objective: To investigate the risks and contingency plans of epidural anesthesia in lumbar transforaminal endoscopic surgery. Study Design: A retrospective analysis of all lumbar transforaminal endoscopic surgeries performed from 2010 to 2014. Setting: Kanghua hospital. Methods: Patients treated with local and epidural anesthesia were divided into 2 groups. In local anesthesia group (A) and local anesthesia group (B), 0.5% lidocaine and 0.25% ropivacaine was administered, respectively. The incidences of complications, including urological complications, in each surgical group as well as Oswestry disability idex (ODI) improvement rates, postoperative patient satisfaction rates, and x-ray exposure times were assessed. Results: From 2010 to 2014, there were 286 cases of lumbar transforaminal endoscopic surgeries, 121 cases utilizing local anesthesia and 165 cases utilizing epidural anesthesia. In cases in which neurological complications occurred after surgery, 15 cases involved nerve root numbness, including one case of foot drop and 2 cases of cerebrospinal leakage in the local anesthesia group, which accounted for 12.4% of group A. However, in the epidural anesthesia group, which accounted for 9.70% of group B, there were 16 cases of nerve root numbness, including 2 cases of foot drop and 2 cases of cerebrospinal leakage. No significant difference was detected in the incidence of neurological complications between the 2 groups (P &gt; 0.05). The ODI improvement rates were 86.0% in the local anesthesia group and 85.4% in the epidural anesthesia group (P &gt; 0.05). The average x-ray exposure times were 14.7 seconds and 16 seconds in the local anesthesia group and epidural anesthesia group, respectively (P &gt; 0.05). The postoperative patient satisfaction rates were 73.6% and 91% in the local anesthesia group and epidural anesthesia group, respectively (P &lt; 0.001). Limitations: This was a single-blind study, and the complications observed were related to the learning curve; all these factors may lead to biases. Conclusions: Epidural anesthesia in transforaminal lumbar surgery is feasible and safe, and no significant difference in neurological complications was observed between the epidural anesthesia and the local anesthesia groups. However, for the patients concerned, the postoperative patient satisfaction rate was significantly greater in the epidural anesthesia group. It is noteworthy that the x-ray exposure times of the groups were not significantly different. Key words: Epidural anesthesia, transforaminal lumbar surgery, neurological complications, cerebrospinal leak

The role of copy and paste function in orthopedic trauma progress notes

The electronic medical record (EMR) is standard in institutions. While there is not concern for legibility of notes and access to charts, there is an ease of copy and paste for daily notes. This may not lead to accurate portrayal of patient's status. Our purpose was to evaluate the use of copy and paste functions in daily notes of patients with injuries at high risk for complications. IRB approval was obtained for a retrospective review. Inclusion criteria included patients aged 18 and older treated at our Level 1 Trauma Center after implementation of Epic Systems Corporation, Verona, WI, USA. Those who were surgically treated for bicondylar tibial plateau fracture, or open tibial shaft fracture type I or II were included. Manual comparison of daily progress to the previous day's note was carried out. Comparisons were made by evaluating the subjective, objective, and plan portions of the notes, coded nominally using 1 for a change 0 for remaining the same. 38 patients' charts were reviewed during a 10-month (July 2012-April 2013) period, and the average length of stay was 12 days (range: 2-35). A total of 418 notes were compared. The overall average of copied data was 85% daily. In the subjective portion, 85-97% of the data was copied on a daily basis and 71-92% of the data was copied within the objective portion of the notes. There were 15 medical complications necessitating intervention. Of these medical complications, the note the day after the complication reflected the event in 10 out of 15, or 70%, of the complications. Thus 5, or 30%, of the patients did not have notes reflecting the complication (p<0.05). There were 7 complications related to the injuries: 4 cases of compartment syndrome, 1 case of foot drop, representing a change in neurologic status, an amputation, and a wound infection treated with antibiotics. Four of the 7 complications (57%) were not reflected in the notes the following day after the complication (p<0.05). There were 54 planned returns to the operating room for procedures, yet 30 of the 54 (56%) notes regarding planned surgical procedures notes did not accurately report the plan for surgery (p<0.05). There were 4 patients with unplanned trips to the operating room and 3 of the notes (75%) did not reflect this (p<0.05). Twelve patients (32%) did not have notes accurately reflecting discharge plans and/or destination (p<0.05). Our results demonstrated widespread use of copy and paste function. We encourage evaluation of the charts by comparing notes to check and a plan to minimize this practice. There needs to be consistent note writing guidelines and appropriate templates used. This will decrease the inaccuracies in the chart and provide a clear picture of the patient, their injuries, and current status.

P633: A rare case of foot drop in children – diagnostic and electrophysiological aspects

P633: A rare case of foot drop in children – diagnostic and electrophysiological aspects

Foot Drop Caused by Single-Level Disc Protrusion Between T10 and L1

Retrospective investigation of surgical treatment of 25 patients with foot drop from single-level disc protrusion in the region of T10 to L1. To describe cases of foot drop from single-level disc protrusion in the region of T10 to L1 and surgical outcomes. Three cases of foot drop from T12-L1 disc protrusion are reported in the literature. Little is known, however, about foot drop resulting from single-level disc protrusion between T10 and L1 or its surgical outcomes. Between January 1995 and October 2010, a total of 25 patients (mean age: 44 yr; range, 21-68 yr) presented to our department with single-level disc protrusion between T10 and L1 (6 at T10-T11, 7 at T11-T12, and 12 at T12-L1) with associated foot drop and without cervical or lumbar spinal stenosis or other neurological disease. The average follow-up period was 46.5 months. We treated all cases surgically with circumferential decompression with fixation. We assessed neurological status, tibialis anterior muscle strength, magnitude of local kyphosis, and cross-sectional area at the level of compression of the dural sac preoperatively and at the final follow-up. Preoperatively, all 25 patients exhibited both foot drop resulting from a lower motor neuron lesion and pathological reflexes resulting from an upper motor neuron lesion. Postoperatively, the mean calculated muscle strength recovery rate was 95%. Mean Japanese Orthopaedic Association score increased from 5.92 ± 1.22 points preoperatively to 9.56 ± 0.92 points at the final follow-up. Magnetic resonance imaging indicated that the cross-sectional area increased from 36.3 ± 7.3 mm2 preoperatively to 133.1 ± 6.1 mm2 postoperatively. Foot drop can be caused by single-level disc protrusion between T10 and L1 and is usually associated with an upper motor neuron lesion. Pathological reflexes resulting from disc protrusion occurring between T10 and L1 differ depending on the level of the protrusion. Circumferential decompression with fixation may be an effective treatment option for this syndrome. 4.

Sequential Compression Device May Cause Peroneal Nerve Palsy

This article presents 2 cases of foot drop after joint replacement surgery that presented after sequential compression device application. In both cases, intact peroneal nerve function was documented by the surgeon in the recovery room prior to sequential compression device application. We believe that excessive pressure over the superficial aspect of the peroneal nerve in conjunction with decreased pain stimulus from analgesia may have contributed to these complications. We maintain sequential compression devices are the current mechanical thromboprophylaxis of choice; however, 4 recommendations are made to minimize the chances of this potential complication. First, precise attention should be given to patients who are short statured, as these patients can be more susceptible to having a sequential compression device improperly placed over the peroneal nerve at the fibular neck. Second, we recommend different size options become more widely available to accommodate varying patient sizes such that placement of the device is ensured to be distal to the fibular neck. Third, when using sequential compression device brands that have hook and look fastener straps, the straps should not be tight on application and frequent skin checks should be made to look for signs of over-compression. Lastly, we recommend considering delaying postoperative application of the sequential compression device until resolution of sensation following spinal or epidural anesthetic.

Long-term outcome of lumbar disc surgery: an experience from Pakistan

The author conducted a study to determine the long-term outcome of lumbar disc surgery on relief of sciatic leg pain. This was a retrospective observational study conducted at Fauji Foundation Hospital, Rawalpindi, Pakistan. The author reviewed medical records of 68 patients who underwent lumbar disc surgery for sciatic pain during the period 1995-2004. All patients were physically examined and interviewed. Lumbar disc surgery yielded complete pain relief in 79.41% of the cases. In 14.7% of the cases surgery failed to give any pain relief, and in 5.88% it yielded partial pain relief. At up to 10 years postoperatively, 27.77% of patients remained absolutely pain free. Pain recurred in 12.82% of cases after 1 year, in 35.89% during the first 5 years, and in 51.28% after 10 years. Pain recurred in the same leg in 63.88%, in the contralateral leg in 19.44%, and in both legs in 16.66%. Neurological deficits did not improve in any case except in 1 case of foot drop. New neurological deficits developed postoperatively in 8.82% of cases in the form of foot drop and calf muscle weakness. Surgery provided immediate pain relief in 79.41% of cases, but the long-term outcome of lumbar disc surgery was not satisfactory.