Recovery of ankle dorsiflexion weakness following lumbar decompressive surgery

Ghahreman, Ali; Ferch, Richard; Rao, P J; Chandran, Nadana; Shadbolt, Bruce

doi:10.1016/j.jocn.2008.10.017

Cited by 52 publications

(50 citation statements)

References 25 publications

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“…The former corresponds to pretibialis anterior muscle strength in the current study. Other predictors are age at surgery [6,7,16], herniated soft disc [7,12,13], and involvement of a single level [7]. In the current study, the two main predictors (pretibialis anterior strength and the duration of drop foot before surgery) were confirmed by the Bayesian network models as direct predictors.…”

Section: Discussionsupporting

confidence: 57%

“…Predictors for residual drop foot in previous studies are varied, but the two main predictors have been preoperative motor weakness [1,3,6,12,16,17,21] and the duration of drop foot before surgery [2,3,7,16,17]. The former corresponds to pretibialis anterior muscle strength in the current study.…”

Section: Discussionmentioning

confidence: 67%

“…Prior work using traditional analytic approaches (such as multivariate analyses) have suggested that duration of drop foot before surgery and preoperative motor weakness [1,3,16,17] may be associated with recovery of active dorsiflexion after decompressive lumbar spine surgery; however, this is somewhat controversial, since other studies did not identify one or either of these factors as important in anticipating a patient's neurologic recovery [2,6,7,12,13,21]. We believe that those analytic approaches may not be ideal for this purpose because they are difficult to describe layered correlations among predictors, and we believe that Bayesian network analysis, which is graphic and intuitive to the clinician, may be better suited to the task because this approach readily describes the layered correlation among predictors.…”

Section: Discussionmentioning

confidence: 99%

“…Drop foot was defined as a tibialis anterior muscle strength score less than 3 (of 5) [1,2,6,8]. Tibialis anterior muscle strength was graded as 3-when patients could dorsiflex and invert their ankles while they were seated but could not achieve full ROM.…”

Section: Clinical Assessmentmentioning

confidence: 99%

“…Age at surgery was stratified in three groups (B 40 years, 41-60 years, and C 61 years) based on a previous study in which age was identified as an important predictor [6]. The duration of drop foot before surgery was categorized in two groups (B 30 days and [ 30 days) for two reasons.…”

Section: Candidate Variables and Outcomesmentioning

confidence: 99%

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Prediction of Postoperative Clinical Recovery of Drop Foot Attributable to Lumbar Degenerative Diseases, via a Bayesian Network

Takenaka

Aono

2017

Clinical Orthopaedics &Amp; Related Research

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Background Drop foot resulting from degenerative lumbar diseases can impair activities of daily living. Therefore, predictors of recovery of this symptom have been investigated using univariate or/and multivariate analyses. However, the conclusions have been somewhat controversial. Bayesian network models, which are graphic and intuitive to the clinician, may facilitate understanding of the prognosis of drop foot resulting from degenerative lumbar diseases. Questions/purposes (1) To show a layered correlation among predictors of recovery from drop foot resulting from degenerative lumbar diseases; and (2) to develop support tools for clinical decisions to treat drop foot resulting from lumbar degenerative diseases.Methods Between 1993 and 2013, we treated 141 patients with decompressive lumbar spine surgery who presented with drop foot attributable to degenerative diseases. Of those, 102 (72%) were included in this retrospective study because they had drop foot of recent development and had no diseases develop that affect evaluation of drop foot after surgery. Specifically, 28 (20%) patients could not be analyzed because their records were not available at a minimum of 2 years followup after surgery and 11 (8%) were lost owing to postoperative conditions that affect the muscle strength evaluation. Eight candidate variables were sex, age, herniated soft disc, duration of the neurologic injury (duration), preoperative tibialis anterior muscle strength (pretibialis anterior), leg pain, cauda equina syndrome, and number of involved levels. Manual muscle testing was used to assess the tibialis anterior muscle strength. Drop foot was defined as a tibialis anterior muscle strength score of less than 3 of 5 (5 = movement against gravity and full resistance, 4 = movement against gravity and moderate resistance, 3 = movement against gravity through full ROM, 3À = movement against gravity through partial ROM, 2 = movement with gravity eliminated through full ROM, 1 = slight contraction but no movement, and 0 = no contraction). The two outcomes of interest were postoperative tibialis anterior muscle strength (posttibialis anterior) of 3 or greater and posttibialis anterior strength of 4 or greater at 2 years after surgery. We developed two separate Bayesian network models with outcomes of interest for posttibialis anterior strength of 3 or greater and posttibialis anterior strength of 4 or greater. The two outcomes correspond to ''good'' and ''excellent'' results based on previous reports, respectively. Direct predictors are defined as variables that have the tail of the arrow connecting the outcome of interest, whereas indirect predictors are defined as variables that have the tail of the arrow Each author certifies that neither he, nor any member of his immediate family, have funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for ...

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Clinical Assessmentmentioning

confidence: 99%

Section: Candidate Variables and Outcomesmentioning

confidence: 99%

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Prediction of Postoperative Clinical Recovery of Drop Foot Attributable to Lumbar Degenerative Diseases, via a Bayesian Network

Takenaka

Aono

2017

Clinical Orthopaedics &Amp; Related Research

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Clinical Course of Motor Deficits from Lumbosacral Radiculopathy Due to Disk Herniation

Akuthota

Marshall

Boimbo

et al. 2019

PM&R

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Background The clinical course of motor deficits from lumbosacral radiculopathy appears to improve with or without surgery. Strength measurements have been confined to manual muscle testing (MMT) and have not been extensively followed and quantified in prior studies. Objective To determine if motor weakness and patient‐reported outcomes related to lumbosacral radiculopathy improve without surgical intervention over the course of 12 months. Design Prospective observational cohort. Setting Outpatient academic spine practice. Participants Adults with acute radicular weakness due to disk herniation. Methods Forty patients with radiculopathy and strength deficit were followed over a 12‐month period. Objective strength and performance tests as well as survey‐based measurements were collected at baseline and then every 3 months. Patients underwent comprehensive pain management and rehabilitation and/or surgical approaches as determined in coordination with the treating specialist. This study was approved by the institutional review board of Colorado. Main Outcome Measurements Testing of strength was through MMT, handheld dynamometer, and performance‐based testing. Furthermore, visual analog scale, modified Oswestry Disability Index, and 36‐Item Short Form Health Survey (SF‐36) were used to measure pain and disability outcomes. Results Of the 40 patients, 33 (82.5%) did not have surgery; 7 (17.5%) had surgery. Twenty‐four of the 33 patients (60%) did not undergo surgery and were followed for 12 months (Comprehensive Pain Management and Rehabilitation, Complete [CPM&R‐C]), and 9 (22%) did not have surgery and lacked at least one follow‐up evaluation (Comprehensive Pain Management and Rehabilitation, Incomplete [CPM&R‐I]). No statistically significant differences were found on baseline measures of strength deficits and SF‐36 domains between the CPM&R‐C, Surgery, and CPM&R‐I groups. Pain and disability scores in the Surgery group were significantly higher than in the CPM&R‐C at baseline. There were statistically significant improvements in all areas of strength, pain, and function when comparing measurements at the 12‐month follow‐up to baseline in the CPM&R‐C group. Conclusions Individuals with motor deficits due to lumbosacral radiculopathy improve over time regardless of treatment choice. Most did not choose surgery, and almost all of these patients regained full strength at 1 year. Strength recovery typically occurred in the first 3 months, but there was ongoing recovery over the course of a year. Level of Evidence II

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Factors that influence neurological deficit and recovery in lumbar disc prolapse—a narrative review

Rajasekaran

et al. 2018

International Orthopaedics (SICOT)

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Recovery of ankle dorsiflexion weakness following lumbar decompressive surgery

Cited by 52 publications

References 25 publications

Prediction of Postoperative Clinical Recovery of Drop Foot Attributable to Lumbar Degenerative Diseases, via a Bayesian Network

Prediction of Postoperative Clinical Recovery of Drop Foot Attributable to Lumbar Degenerative Diseases, via a Bayesian Network

Clinical Course of Motor Deficits from Lumbosacral Radiculopathy Due to Disk Herniation

Factors that influence neurological deficit and recovery in lumbar disc prolapse—a narrative review

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