CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ghai, A.
Right arrow Articles by Bansal, P.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Ghai, A.
Right arrow Articles by Bansal, P.
Canadian Journal of Anesthesia 52:996-997 (2005)
© Canadian Anesthesiologists' Society, 2005

Correspondence

REPLY

Anju Ghai, MD, Sarla Hooda, MD, Prashant Kumar, MD, Raman Kumar, MD and Pankaj Bansal, MD

Sharma Post Graduate Institute of Medical Sciences, Haryana, India, E-mail: prashantkumarz{at}yahoo.com

This is in response to the letter from Dr. Naveen Eipe and Dr. Nihar Ranjan, regarding the above mentioned article in the May 2005 issue of the Canadian Journal of Anesthesia. I thank Dr. Naveen for his comments, and would like to clarify the points raised by him.

There was no documentation of preoperative neurological deficit in the basic trauma examination. It is quite true that trauma to the lumbosacral spine can result in bilateral foot drop, but this was ruled out in the preanesthetia visit and the magnetic resonance imaging done postoperatively. The patient did not have any other coexisting disease with subclinical neuropathy (diabetes), although pre-existing neurological disease should also be ruled out e.g., lumbar disc syndrome or spondylitis or recent herpes zoster in such cases. The tibial pins were inserted on both sides, and the femur alone was operated during the first stage. The legs were surgically reduced in the second stage, so the foot drop could easily be related to the surgery. The patient was operated in the lateral position, no femoral traction was applied (on the hip table). We agree that the sciatic nerve compression in the lateral position could again be a factor (but unilateral).

Since the patient had no neurological deficit pre-operatively, a neurologist’s opinion was not sought. Consultation was undertaken postoperatively, after the patient developed foot drop. There was no documentation of the presence of foot drop at admission or after the insertion of tibial pins (bilateral) so the etiology was most likely related to surgery or spinal anesthesia. Bilateral foot drop after spinal anesthesia is possible only if lumbar puncture is performed above the third lumbar segment, which is uncommon. Considering the angle of entry of the spinal needle, trauma to one side of the conus is possible.

We emphasize that this case is not meant to attribute blame, but to highlight that this complication, though rare, does occur, and has its own medicolegal implications.





This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ghai, A.
Right arrow Articles by Bansal, P.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Ghai, A.
Right arrow Articles by Bansal, P.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS