Abstract
ObjectiveThe purpose of this study was to analyze the clinical features and prognostic factors of surgical outcome of foot drop caused by lumbar degenerative disease and put forward the clinical stage.MethodsWe retrospectively reviewed 135 patients with foot drop due to lumbar degenerative disease. The clinical features and mechanism were analyzed. Age, sex, duration of palsy, preoperative muscle strength of tibialis anterior (TA), sensation defect of affected lower limb, affected foot, diagnosis and compressed nerve roots were recorded and compared with surgical outcome.ResultsFoot drop was observed in 8.1% of all inpatients of lumbar degenerative disease. L5 nerve root compression was observed in 126 of all 135 patients (93.3%). Single, double and triple roots compression was observed respectively in 43, 83, and 9 patients (31.9%, 61.5%, and 6.6%). But there was no significant relationship between preoperative muscle strength of TA and the number of compressed roots. The muscle strength of TA was improved in 113 (83.7%) patients after surgery, but it reached to >=4 in only 21 (15.6%) patients. Improvement of the muscle strength of TA was almost stable at the 6-month follow-up. At the last follow-up, the muscle strength of TA was 1, 2, 3, 4, 5 respectively in 28, 24, 62, 13, 8 patients. Multivariate logistic regression showed duration of palsy (p=0.0360, OR=2.543), preoperative muscle strength of TA (p=0.0064, OR=5.528) and age (p=0.0309, OR=3.208) were factors that influenced recovery following an operation.ConclusionsL5 nerve root was most frequently affected. The muscle strength of TA improved in most patients after surgery, but few patients can get a good recovery from foot drop. Patients of shorter duration of palsy, better preoperative muscle strength of TA and younger age showed a better surgical outcome.
Highlights
Foot drop is characterized by the inability or difficulty in moving the ankle and toes upward
We analyzed the duration of foot drop before operation, preoperative muscle strength of tibialis anterior (TA), age, sex, sensation defect of affected lower limb, affected foot, diagnosis and compressed nerve roots to determine which is the prognosis factor comparing the recovered with unrecovered patients
To analyze the synergistic effect of multiple factors which may influence surgical outcome, multivariate logistic regression analysis using stepwise selection was performed
Summary
Foot drop is characterized by the inability or difficulty in moving the ankle and toes upward (dorsiflexion). It is a sign of an underlying neurological, muscular or anatomical problem. Foot drop is the result of neurological disorder; only rarely is the muscle diseased or nonfunctional. The source for the neurological impairment can be central (motor neuron disease, parasagittal cortical or subcortical cerebral lesions) or peripheral (lumbar radiculopathy, mononeuropathies of the deep peroneal, common peroneal, or sciatic nerves) [1,2,3]. Lumbar degenerative disease (LDD) including lumbar disc herniation (LDH) and lumbar spinal stenosis (LSS) is a common etiology for low back pain and leg pain. Few studies have addressed this phenomenon [11,12,13,14]
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