Peselzon Oleg, Colditz Michael, Maclachlan Liam R
1Department of Neurosurgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
2Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; and.
J Neurosurg Case Lessons. 2023 Jan 30;5(5). doi: 10.3171/CASE22499.
New-onset adult foot drop is commonly encountered in neurosurgical practice and has a broad differential, including radiculopathy, peroneal nerve palsy, demyelinating diseases, and central causes. Etiology is commonly identified with comprehensive history, examination, imaging, and investigations. Despite familiarity with the management of lumbar spondylosis and peroneal nerve compression causes, rare or uncommon presentations of nonsurgical causes are important to consider in order to avoid nonbeneficial surgery.
The authors report a very uncommon cause of foot drop: new-onset isolated L5 mononeuritis in a 61-year-old nondiabetic male. They provide a review of the etiology and diagnosis of foot drop in neurosurgical practice and detail pitfalls during workup and the strategy for its nonsurgical management.
Uncommon, nonsurgical causes for foot drop, even in the setting of degenerative lumbar spondylosis, should be considered during workup to reduce the likelihood of unnecessary surgical intervention. The authors review strategies for investigation of new-onset adult foot drop and relate these to an uncommon cause, an isolated L5 mononeuritis, and detail its clinical course and response to treatment.
新发成人足下垂在神经外科实践中较为常见，其鉴别诊断范围广泛，包括神经根病、腓总神经麻痹、脱髓鞘疾病以及中枢性病因。病因通常通过全面的病史、体格检查、影像学检查及相关检验来确定。尽管熟悉腰椎间盘突出症和腓总神经受压病因的处理，但为避免无益的手术，考虑罕见或不常见的非手术病因也很重要。
作者报告了一例非常罕见的足下垂病因：一名61岁非糖尿病男性新发孤立性L5单神经炎。他们回顾了神经外科实践中足下垂的病因及诊断，并详述了检查过程中的陷阱及其非手术治疗策略。
在检查过程中，即使在退行性腰椎间盘突出症的情况下，也应考虑足下垂的罕见非手术病因，以降低不必要手术干预的可能性。作者回顾了新发成人足下垂的检查策略，并将其与一种罕见病因——孤立性L5单神经炎相关联，详述了其临床病程及治疗反应。
