Differential Diagnosis for One Foot Colder than the Other after Spinal Surgery

Single Most Likely Diagnosis

• Sympathetic nerve injury or dysfunction: This is a common complication after spinal surgery, particularly if the surgery involved the thoracic or lumbar spine. The sympathetic nerves can be damaged during the procedure, leading to a disruption in the normal sympathetic outflow to the lower extremities, resulting in temperature differences between the feet.

Other Likely Diagnoses

• Peripheral nerve injury: Direct injury to the peripheral nerves during spinal surgery can cause sensory and motor deficits, including temperature sensation abnormalities.
• Spinal cord injury or ischemia: Incomplete spinal cord injuries or ischemia can affect the spinal cord's ability to regulate temperature, leading to differences in temperature between the feet.
• Hematoma or abscess: A postoperative hematoma or abscess can compress or damage the spinal cord or nerves, causing temperature sensation abnormalities.

Do Not Miss Diagnoses

• Aortic dissection or occlusion: Although rare, aortic dissection or occlusion can occur after spinal surgery, particularly if the patient has underlying vascular disease. This is a life-threatening condition that requires immediate attention.
• Spinal epidural hematoma: A spinal epidural hematoma can compress the spinal cord, leading to neurological deficits, including temperature sensation abnormalities. Prompt diagnosis and treatment are crucial to prevent permanent damage.
• Infection (e.g., osteomyelitis, discitis): Postoperative infections can cause a range of symptoms, including temperature differences between the feet. Early diagnosis and treatment are essential to prevent serious complications.

Rare Diagnoses

• Complex regional pain syndrome (CRPS): CRPS is a rare condition characterized by chronic pain, inflammation, and nerve damage. It can cause temperature differences between the feet, but it is a less common diagnosis in this context.
• Vasculitis or vasospasm: Vasculitis or vasospasm can cause temperature differences between the feet, but these conditions are rare and typically have other associated symptoms.
• Neurological conditions (e.g., multiple sclerosis, peripheral neuropathy): Underlying neurological conditions can cause temperature sensation abnormalities, but these conditions are typically diagnosed before spinal surgery.