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Case Reports
. 2024 Dec 30;16(12):e76653.
doi: 10.7759/cureus.76653. eCollection 2024 Dec.

Femoral Nerve Injury After Prone-Position Lumbar Discectomy: A Case Report Highlighting the Role of Ultrasound in Recovery Monitoring

Mamoru Matsuo  1   2 , Yoshitaka Nagashima  2 , Yusuke Nishimura  2 , Ryuta Saito  2
Affiliations
Case Reports

Femoral Nerve Injury After Prone-Position Lumbar Discectomy: A Case Report Highlighting the Role of Ultrasound in Recovery Monitoring

Mamoru Matsuo et al. Cureus. .

Abstract

Postoperative peripheral nerve injuries are well-recognized complications of surgical positioning. In prone spinal surgeries, lateral femoral cutaneous nerve injuries are common, but femoral nerve injuries are rare. We present a case of femoral nerve injury following prone-position spinal surgery, highlighting the role of ultrasound imaging in diagnosis and management. A 79-year-old man developed anterior thigh pain, along with iliopsoas and quadriceps weakness, following lumbar discectomy at the L3/4 and L4/5 levels. Neurological evaluation revealed a positive Tinel-like sign over the rectus femoris near the inguinal ligament. Ultrasound showed no hematoma but suggested nerve traction or compression. Targeted rehabilitation significantly improved pain, muscle strength, and function within two weeks. Ultrasound imaging confirmed enhanced femoral nerve mobility, which correlated with symptom resolution. This case highlights the importance of distinguishing femoral nerve injuries from radiculopathy and demonstrates the utility of ultrasound for diagnosis and monitoring recovery. Although femoral nerve injuries in prone surgeries are uncommon, awareness and early rehabilitation are critical for favorable outcomes.

Keywords: femoral nerve; nerve gliding; postoperative peripheral nerve injury; postoperative rehabilitation; prone-position surgery; rectus femoris; tinel-like sign; ultrasound.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Preoperative MRI
(A) Sagittal. (B, C) Axial. T2-weighted MRI performed preoperatively showing lumbar disc herniation (white arrow).
Figure 2
Figure 2. Postoperative MRI
(A) Sagittal. (B,C) Axial. T2-weighted MRI performed postoperatively after 10 days showing good decompression in the spinal canal.
Figure 3
Figure 3. Ultrasound of the area with a positive Tinel-like sign
The anatomical relationship between the muscles and the nerves in the anterior aspect of the right thigh is illustrated. The dashed rectangle indicates the position where the ultrasound probe was applied. Image credit: Original creation.
Figure 4
Figure 4. Ultrasonography conducted above the rectus femoris (RF) at the site exhibiting a positive Tinel-like sign
During severe pain (A), the gap (indicated by a white arrowhead) through which the femoral nerve passed was observed. Upon symptom improvement (B), this gap was enlarged, and nerve gliding was notably enhanced.
See this image and copyright information in PMC

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