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Background and Aims New neurological deficits after spinal surgery are rare but serious. A quick diagnosis and treatment are crucial to prevent permanent damage. We report a case of transient neurological deficit following endoscopic lumbar lateral recess decompression, likely caused by inadvertent ropivacaine diffusion into the epidural space.

Methods A 58-year-old male, ASA-PS II, underwent endoscopic L5-S1 decompression for lumbar stenosis. He received general anesthesia and local anesthetic wound infiltration with 10 ml of 0.75% ropivacaine after surgery. Intraoperative period was uneventful. Upon emergence, the patient had no neurological deficits. Fifteen minutes later, he developed painless paraplegia and anesthesia below L3. MRI was unavailable, so a CT scan was performed.

Results The CT scan showed no abnormalities. Multidisciplinary team, consisting of orthopedic, neurology and anesthesiology consultants, agreed to prepare for an emergent decompressive laminectomy. However, on the way to the operating room, approximately 2h from new onset deficits, the patient’s neurological symptoms started gradually improving. Surgery was halted, and the patient fully recovered within 3 hours. He was discharged home the next day fully recovered and with no further events.

Conclusions This case suggests inadvertent ropivacaine spread to the epidural space as a possible cause of transient neurological deficits after lumbar spine surgery. Anesthesiologists should consider this in their differential diagnosis. Early CT scan can be helpful when MRI is unavailable.