Acute Bilateral Foot Drop from Degenerative Spinal Disease: Case Series Insights

Overview

Acute bilateral foot drop is an exceptionally rare presentation, particularly when caused by degenerative spinal disease. This case series of seven patients highlights clinical features, radiological findings, and outcomes, revealing that not all cases are associated with cauda equina syndrome and that timely surgical intervention can lead to significant recovery.

Background

Foot drop is characterized by weakness in ankle dorsiflexion and can arise from various pathologies along the neural and muscular pathways. While chronic bilateral foot drop is often linked to systemic or neuromuscular diseases, acute bilateral foot drop is rare and most commonly results from bilateral common peroneal nerve palsies. Degenerative spinal disease as a cause is even less frequent, with only six cases previously reported. Understanding the clinical presentation and management of this rare condition is essential for prompt diagnosis and treatment.

Data Highlights

Key Findings

• Acute bilateral foot drop due to degenerative spinal disease is extremely rare, with only a handful of cases reported prior to this series.
• Most patients presented with severe dorsiflexion weakness (≤2/5 power) and painful foot drop.
• Only 3 of 7 patients had concomitant cauda equina syndrome, indicating that bilateral foot drop can occur independently of CES.
• The most commonly affected spinal level was L3/4, though pathology ranged from L2/3 to L5/S1.
• Five patients achieved full recovery of ankle dorsiflexion after surgical decompression, emphasizing the importance of timely intervention.
• Multiple patients required repeated healthcare visits before referral, highlighting diagnostic challenges in non-specialist settings.

Clinical Implications

Clinicians should consider degenerative spinal disease in the differential diagnosis of acute bilateral foot drop, even in the absence of cauda equina syndrome. Early recognition and prompt surgical decompression can result in favorable neurological recovery. Awareness of this rare presentation may reduce delays in diagnosis and improve patient outcomes.

Conclusion

This case series expands understanding of acute bilateral foot drop caused by degenerative spinal pathology, demonstrating that it can occur with or without cauda equina syndrome and that timely surgery often leads to significant functional improvement.

References

1. Acute Bilateral Foot Drop Associated with or Independent of Cauda Equina Syndrome: A Case Series Analysis