Post-Surgery Challenges: Left Heel Weakness After T12 Spine Injury

After the T12 spinal surgery, the left heel is unable to bear weight?

Hello Doctor, I suffered a burst fracture of the T12 vertebra in October last year, and underwent surgery where screws were placed from T10 to L2, with bone cement applied to T12.
Postoperatively, I have been unable to support my left heel, and after being referred to a psychiatrist for an electromyogram, it was confirmed that there is reduced strength in the left foot's dorsiflexion.
However, I do not experience any numbness or pain.
I would like to ask the doctor: 1.
What could be the possible causes of this condition? 2.
If the screws are not removed, could this lead to degeneration of the adjacent joints, and would removing them improve the situation? Thank you for taking the time to respond, Doctor.

Xiao Xiansheng, 30~39 year old female. Ask Date: 2021/01/19

Dr. Wang Shouji reply Orthopedics

Hello, it is important to pay attention to the degree of nerve compression.
If temporary stabilization is not suitable and fusion is not performed, it may be appropriate to remove it.
Changhua Hospital cares about your health.
Wang Shou-ji.

Reply Date: 2021/01/19

More Info

After a T12 vertebral burst fracture and subsequent surgery involving instrumentation from T10 to L2, it's understandable to have concerns regarding post-operative challenges, particularly with left heel weakness. Let's address your questions in detail.

1. Possible Causes of Left Heel Weakness: The weakness in your left heel could be attributed to several factors. Given the nature of your injury and the surgical intervention, the most likely cause is related to nerve involvement. The T12 vertebra is located in the thoracic region of the spine, and while it primarily affects the lower body, the nerves that control the muscles in your legs and feet originate from the lumbar and sacral regions. If there was any swelling, bruising, or direct trauma to the spinal cord or nerve roots during the injury or surgery, it could lead to weakness in specific muscle groups. Additionally, muscle atrophy can occur due to disuse following your injury and surgery, which can further exacerbate weakness. The electromyography (EMG) results indicating reduced strength in the left foot suggest that there may be some degree of nerve compromise or muscle disuse.

2. Impact of Retaining or Removing Bone Screws: The concern about joint degeneration due to retained hardware is valid. In some cases, the presence of screws and rods can lead to adjacent segment disease, where the joints above or below the surgical site experience increased stress and potential degeneration. However, the decision to remove hardware should be made carefully. If the screws are not causing any pain or discomfort and are not contributing to any functional limitations, many surgeons prefer to leave them in place. Removal of hardware can be a separate surgical procedure that carries its own risks, including infection and further complications. If the weakness in your heel is significantly impacting your mobility or quality of life, discussing the potential benefits and risks of hardware removal with your orthopedic surgeon is advisable.

Additional Considerations: Rehabilitation plays a crucial role in recovery after spinal surgery. Physical therapy focusing on strengthening exercises for the lower extremities, particularly the muscles that control ankle and foot movement, can be beneficial. Your therapist may also incorporate neuromuscular re-education techniques to help improve coordination and strength in the affected areas.
It's also important to monitor for any changes in sensation or pain, as these could indicate changes in nerve function. If you experience any new symptoms, such as numbness, tingling, or increased weakness, it’s essential to communicate these to your healthcare provider promptly.

In summary, the weakness in your left heel could be due to nerve involvement or muscle atrophy following your T12 injury and surgery. The decision to remove bone screws should be made based on a thorough evaluation of your current symptoms and functional status. Engaging in a structured rehabilitation program will be key to improving strength and function in your left foot. Always consult with your healthcare team for personalized advice tailored to your specific situation.

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