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Quick Case

Treating Spontaneous Foot Weakness Causing Immobility


FIGURE 1. Sagittal magnetic resonance
imaging obtained preoperatively shows spondylolisthesis at L5/S1 and stenosis at L4/5 and L5/S1

A 69-year-old woman presented at Duke with weakness in both feet that caused her to be unable to walk without the use of an ambulation device.

The patient explained that, 2 weeks prior, she had been in a crouching position when she stood up and spontaneously experienced weakness in both feet and her toes. She was not experiencing pain.

After 2 visits to the emergency department, being hospitalized for several days, and undergoing magnetic resonance imaging, the patient had not received a diagnosis or treatment. Frustrated and concerned about what the symptoms meant for her mobility, she was referred to Duke and orthopaedic spine surgeon Norah Foster, MD.

A review of the earlier findings on magnetic resonance imaging of the patient’s lower spine revealed stenosis, which was likely causing the weakness in her feet. Radiography was obtained and revealed arthritis in the lumbosacral joint (L5-S1) and spondylolisthesis at the L4-L5 spinal segment (Figure 1). A brief, 5-day course of steroids provided the patient no benefit.

Question: How did Foster restore feeling and mobility in the patient’s feet? 

View case conclusion ➧

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