Disclosures: Muhammad Ahsan, DO: No financial relationships or conflicts of interest

Case Diagnosis: Lumbar disc herniation leading to bilateral foot drop

Case Description: A 28-year-old female with no significant past medical history presented to the ED with new-onset bilateral foot weakness. Patient initially presented several weeks prior due to new-onset lower back pain after lifting heavy boxes at work. The pain was 8/10 in severity with no radicular or red flag signs or symptoms. Computed tomography scan of the lumbar spine showed no significant abnormalities except mild multilevel degenerative changes. She was prescribed a Medrol dose pack, Robaxin, and gabapentin and discharged home. She reported no improvement in her pain despite starting these medications. A few weeks later the patient developed new radiating pain and paresthesia from her lower back down the posterior aspect of her bilateral calves. One day later she developed sudden onset bilateral foot drop without any signs of the cauda equina syndrome. Lumbar magnetic resonance imaging was significant for central disc extrusion at the L3-L4 level causing severe stenosis and ventral effacement of the thecal sac.

Setting: Tertiary hospital

Assessment/Results: The patient underwent an L3 and L4 discectomy with laminectomy. The patient continued to demonstrate bilateral foot drop post-op. She was discharged to acute inpatient rehab. Patient was fitted for custom bilateral AFOs. The patient showed tremendous improvement and was modified independent by the end of her rehab stay.

Discussion: Foot drop is common and often unilateral. Progressive bilateral foot drop can be seen with various metabolic conditions. Acute onset of bilateral foot drop due to disc herniation is extremely rare with only a few reported cases.

Conclusion: Acute isolated bilateral foot drop due to lumbar disc herniation is a very rare condition. Early decompression and rehab have shown good recovery of the deficits.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/lumbar-disc-herniation-exhibiting-as-bilateral-foot-drop/