Abstract
When patients presenting with subjective lower limb weakness (SLLW) are encountered, it is natural to suspect a lumbar pathology and proceed with related clinical examination, investigations and management. However, SLLW could be a sign of degenerative cervical myelopathy (DCM) due to an evolving cord compression. In such circumstances, if symptoms are not correlated to myelopathy at the earliest, there could be potential complications over time. In this study, we intend to analyse the outcomes after surgical management of the cervical or thoracic cord compression in patients with SLLW. Retrospectively, patients who presented to our center during the years 2010–2016 with sole complaint of bilateral SLLW but radiologically diagnosed to have a solitary cervical or thoracic stenosis, or tandem spinal stenosis and underwent surgical decompression procedures were selected. Their clinical presentation was categorised into three types, myelopathy was graded using Nurick’s grading and JOA scoring; in addition, their lower limb functional status was assessed using the lower extremity functional scale (LEFS). Functional recovery following surgery was assessed at 6 weeks, 3 months, 6 months, one year, and two years. Selected patients (n = 24; Age, 56.4 ± 10.1 years; range 32–78 years) had SLLW for a period of 6.4 ± 3.2 months (range 2–13 months). Their preoperative JOA score was 11.3 ± 1.8 (range 7–15), and LEFS was 34.4 ± 7.7 (range 20–46). Radiological evidence of a solitary cervical lesion and tandem spinal stenosis was found in 6 and 18 patients respectively. Patients gradually recovered after surgical decompression with LEFS 59.8 ± 2.7 (range 56–65) at 1 year and JOA score 13.6 ± 2.7 (range − 17 to 100) at 2 years. The recovery rate at final follow up was 47.5%. Our results indicate the importance of clinically suspecting SLLW as an early non-specific sign of DCM to avoid misdiagnosis, especially in patients without conventional upper motor neuron signs. In such cases, surgical management of the cord compression resulted in significant functional recovery and halted the progression towards permanent disability.
Highlights
When patients presenting with subjective lower limb weakness (SLLW) are encountered, it is natural to suspect a lumbar pathology and proceed with related clinical examination, investigations and management
Even though the predominant complaint may be lower limb weakness favouring the possibility of lumbar stenosis, meticulous evaluation to elicit signs of myelopathy and appropriate radiologic screening of the entire spine should be performed to rule out other potential sites of cord compression[12]
We intend to, (1) Develop an organized algorithm to evaluate and delineate an optimal management strategy for patients presenting with SLLW but having radiological evidence of a solitary cervical or thoracic lesion, or tandem spinal stenosis
Summary
When patients presenting with subjective lower limb weakness (SLLW) are encountered, it is natural to suspect a lumbar pathology and proceed with related clinical examination, investigations and management. Our results indicate the importance of clinically suspecting SLLW as an early non-specific sign of DCM to avoid misdiagnosis, especially in patients without conventional upper motor neuron signs In such cases, surgical management of the cord compression resulted in significant functional recovery and halted the progression towards permanent disability. Even though the predominant complaint may be lower limb weakness favouring the possibility of lumbar stenosis, meticulous evaluation to elicit signs of myelopathy and appropriate radiologic screening of the entire spine should be performed to rule out other potential sites of cord compression[12] This may reveal a solitary compression at the cervical or thoracic region, or tandem spinal stenosis where there is a cervical stenosis in concomitance with stenosis at a lower level[13,14]. (1) Develop an organized algorithm to evaluate and delineate an optimal management strategy for patients presenting with SLLW but having radiological evidence of a solitary cervical or thoracic lesion, or tandem spinal stenosis
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