Reactions 1118 - 9 Sep 2006

Bupivacaine

Foot drop following spinal anaesthesia in a patientwith a low-lying cord: case report

Foot drop occurred in a 26-year-old woman after spinalanaesthesia with bupivacaine for caesarean section.

The woman underwent spinal anaesthesia using a 22-gaugespinal Quincke needle and 0.5% bupivacaine 1.2mL, in the leftlateral position. The needle was inserted into her spinal canalat L3–4, estimated from the intercristal line. Following surgery,she found that she could not move her right ankle. Atpresentation one month later, she had right foot drop andsome numbness of the right lateral aspect of her ankle.Neurological examination showed hypotonia and motorpower grade 1/5 in her right ankle dorsiflexors. She hadhypoaesthesia in her right L5 dermatome and a high steppinggait. MRI scanning showed a low lying spinal cord at theL4 level and a thick and fatty filium attached to a cerebrospinalfluid-isointense intradural cyst at S3 level. Her spinal corddemonstrated an increased signal between L1 and L3 onT2-weighted image. A coronal MRI myelogram revealedintramedullary cord cavitation. Significant spontaneous motorrecovery to grade 4/5 in her right ankle occurred over thefollowing 6 months.

Author comment: "[O]ur case demonstrates that in somerare cases, even when using Tuffier’s line as a guideline, spinaldamage may not be completely preventable if the cord endsat a much lower level."Ahmad FU, et al. Foot drop after spinal anesthesia in a patient with a low-lyingcord. International Journal of Obstetric Anesthesia 15: 233-236, No. 3, Jul 2006 -India 801044288

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Reactions 9 Sep 2006 No. 11180114-9954/10/1118-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved