• Spine · Mar 2003

    Case Reports

    Medial compartment syndrome of the foot: an unusual complication of spine surgery.

    • Alan K Stotts, Kristen L Carroll, Patrick G Schafer, Stephen D Santora, and Timothy D Branigan.
    • University of Utah School of Medicine, Salt Lake City, Utah, USA. Alan.Stotts@hsc.utah.edu
    • Spine. 2003 Mar 15; 28 (6): E118-20.

    Study DesignDescriptive case report.ObjectivesTo report the case of a child with medial compartment syndrome of the foot following posterior spinal instrumentation and fusion.Summary Of Background DataNo previous study has reported medial compartment syndrome of the foot following spinal surgery.MethodsA 15-year-old female with progressive idiopathic scoliosis was taken for posterior instrumentation and fusion. The patient had a history of severe postexertional cramping in the feet following athletics. Surgery progressed uneventfully and the patient was continuously monitored with somatosensory-evoked potentials, which showed no changes. In the recovery room, the patient complained of severe cramping in one foot that was similar to her postexertional cramping. This was lessened with massage and ketorolac. Soreness continued in the foot into postoperative day one and then increased overnight. On the morning of postoperative day 2, pressure in the medial compartment was found to be 97 mm Hg and she was taken for fasciotomy, which found necrosis of the abductor hallucis muscle, and all other compartments of the foot were normal.ResultsAt the 6-month follow-up, the patient is doing well with no known sequelae.ConclusionThis was a very rare case of medial compartment syndrome of the foot following spine surgery. We believe that the patient had a predisposition, whether neurologic or vascular, toward cramping in the foot and that this activity was stimulated by the nerve stimulation during the evoked potential monitoring. Although the patient had thoracic epidural analgesia after surgery, it was not felt to have contributed to the development or result of the compartment syndrome. We strongly advocate for checking patients feet and legs during surgery for overactivity and stress the need for a high index of suspicion for compartment syndrome for unexplained pain after surgery.

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