Postoperative Foot Drop After Spinal Surgery: Etiology, Presentation, and Management Strategies

» The incidence of postoperative foot drop after spine surgery is estimated at 3.33%, with higher rates reported in complex procedures such as high-grade spondylolisthesis correction (up to 30%). Risk factors include disc-space distraction, deformity corrections, prolonged surgery, and advanced patient age. » The primary mechanisms of postoperative foot drop include direct nerve trauma, stretch injuries from retraction or distraction, compression from hematomas or implants, and ischemic damage because of disrupted blood flow. » Preoperative counseling, intraoperative precision, appropriate disc space distraction, and careful nerve retraction are key to mitigating the risk of foot drop, with ongoing research needed to standardize preventive and management guidelines. » Treatment strategies are tailored to the underlying cause, ranging from conservative options (physical therapy, ankle-foot orthoses, and functional electrical stimulation) to surgical interventions (hematoma evacuation, implant removal, neurolysis, nerve transfer, and tendon transfer), although outcomes are highly variable.