Disclosures: Jason B. Coombs, DO: Nothing to disclose

Case Description: The patient has a history of diabetes, Type II, lumbar stenosis, and a right L5 radiculopathy for which he underwent an L3-L5 decompressive lumbar laminectomy in 2017. Following surgery he experienced acute left foot swelling and burning pain over his forefoot, precipitating the current symptoms. A comprehensive evaluation identified no etiology for the foot swelling. He denies left foot weakness. He has no symptoms proximal to the malleoli, low back pain, or right sided symptoms. A recent lumbar MRI shows advanced disc degeneration at L5-S1, bilateral foraminal narrowing at L5-S1 worse on the left than the right.

Setting: Outpatient neuromuscular/electrodiagnostic laboratory

Patient: The patient is a 66-year-old white male recently referred for electrodiagnostic evaluation of painless, continual left forefoot numbness with intermittent foot pain that causes sleep disturbance 2-4 nights/week.

Assessment/Results: Physical exam was unremarkable. Electrodiagnostic studies revealed a distal, almost symmetrical axonal sensorimotor polyneuropathy, slightly worse on the left, as well as an asymptomatic left L5 radiculopathy.

Discussion: This case report serves show the importance of electrodiagnostic studies in the evaluation of patients with neurological symptoms as they can help supply the correct diagnosis and protect patients from unnecessary surgeries.

Conclusion: This patient likely had his polyneuropathy prior to the lumbar spine surgery, but it was asymptomatic. His post-surgical left foot swelling likely created the equivalent of a compartment syndrome, resulting in damage to the small nerves of the forefoot. This has produced the continual left forefoot numbness and undoubtedly contributes to his foot pain either directly, and/or by predisposing him to injuring the left forefoot due to a lack of protective sensation. Although the patient has a left L5 radiculopathy, it is asymptomatic and he does not need additional surgery at this time.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-unique-case-of-polyneuropathy-unmasked-by-post-surgical-edema-a-case-report/