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World Neurosurg. 2018 Feb;110:319-322. doi: 10.1016/j.wneu.2017.11.128. Epub 2017 Nov 28.

Acute Bilateral Isolated Foot Drop: Changing the Paradigm in Management of Degenerative Spine Surgery with Percutaneous Endoscopy.

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Department of Neurosurgery, Nanoori Suwon Hospital, Suwon, Korea.
Department of Neurosurgery, Nanoori Suwon Hospital, Suwon, Korea. Electronic address:
Department of Neurosurgery, Nanoori Hospital, Seoul, Korea.
Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, Korea.



Acute bilateral isolated foot drop due to lumbar disk prolapse with canal stenosis is rare with only 3 cases reported in literature. Our patient was managed using the percutaneous full endoscopic technique. This is mainly to highlight the ease of access and patient outcome with preoperative and postoperative images to support our minimally invasive treatment for this rare condition.


A 46-year-old male presented with sudden-onset severe back pain with bilateral foot drop. Clinical examination showed a bilateral L5 radiculopathy with normal perianal sensation. Investigations excluded other causes of bilateral foot drop. A magnetic resonance imaging scan showed disk herniation at the right L4-L5 (inferior migrated) and L5-S1 level (paracentral and extraforaminal) with spinal canal stenosis at the L2-L3 and L5-S1 levels due to ligamentum flavum hypertrophy. The patient underwent percutaneous endoscopic stenosis lumbar decompression at the L2-L3 and L5-S1 level. At the right L4-L5, L5-S1 level, transforaminal endoscopic diskectomy was done using the conventional percutaneous approach. The inferior migrated disk of the L4-L5 level was removed using a left L5-S1 contralateral approach. The patient recovered with favorable outcome and added benefits of minimally invasive surgery.


Lumbar disk prolapse with canal stenosis should be considered in patients presenting with bilateral isolated foot drop. To our best knowledge, this is the first report of percutaneous endoscopic treatment to address multiple-lumbar-level pathology for this rare condition of acute bilateral isolated foot drop.


Bilateral foot drop; Endoscopic spine surgery; Minimally invasive

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