Recovery of severe motor deficit secondary to herniated lumbar disc prolapse: is surgical intervention important? A systematic review

Balaji, Vijayalakshmi; Chin, Kuo-Kai; Tucker, Stewart; Wilson, Lester; Casey, Adrian

doi:10.1007/s00586-014-3371-2

Cited by 25 publications

(26 citation statements)

References 22 publications

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“…As the main contributor to low back pain and sciatica, the disease greatly affects people’s work, daily lives and quality of life (Balaji et al 2014; Lagerback et al 2015; Thaler et al 2015), even permanent neurologic deficit and lifelong incontinence due to cauda equina syndrome (Todd 2015). Notably, over 380 thousands patients in USA had to undergo surgical treatments due to lumbar disc disease during between 2000 and 2009 (Yoshihara and Yoneoka 2015), which is only the tip of the iceberg.…”

Section: Introductionmentioning

confidence: 99%

Identification of lumbar disc disease hallmarks: a large cross-sectional study

et al. 2016

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BackgroundLumbar disc disease has a disabling impact on global people with heavy burden on society, mainly consisting of lumbar disc degeneration (LDD) and lumbar disc herniation (LDH). The recently released lumbar disc nomenclature version 2.0 deepens our understandings on the diseases. Consequently, there is an urgent need to clarify the occurrence and distribution features of LDD and LDH in a large-scale sample in terms of the novel version.Question/purposesWe asked: (1) Is there a difference in the occurrence and distribution hallmarks of LDD and LDH in a population-based large-scale sample? (2) Does the novel nomenclature version bring novel vision on lumbar disc disease?MethodsFive thousand two hundred eighty-eight consecutive cases (26,440 lumbar discs) undergoing lumbar spine MRI were retrospectively included from Jan 2008 to Dec 2010 in a territory university hospital. Five hundred nine cases were excluded. There were 2727 males (51.57%) and 2561 females (48.43%) with a mean age of 43.73 years. Both T1 and T2 weighted lumbar MRI images from L1/2 to L5/S1 were profoundly analyzed in axial and sagittal planes. We classified lumbar discs in terms of version 2.0.ResultsThe occurrence of LDH and LDD was 14.18 and 44.23% in average, respectively. Notably, lumbar spine discs were more prone to LDD than LDH. L4/5 was the most frequent level in terms of LDH (26.08%) and LDD (56.09%), followed by L5/S1 (LDH: 24.09%; LDD: 55.33%), then L3/4, L2/3 and L1/2 in ranking order. The prevalence of LDH and LDD in upper lumbar discs from L1/2 to L3/4 was significant lower than the average prevalence rate (P < 0.05). The mean age was 24.70 (±14.81) years for normal lumbar discs; 49.76 (±14.95) years for LDD; 37.01 (±12.91) years for LDH; 51.31(±15.00) years for LDD and LDH (P < 0.05). Modic changes, HIZ, spondylosis deformans and decreased disc height were linked with older age; whereas Schmorl node and lumbar disc sequestration were not associated with age (P < 0.05).ConclusionsThe prevalence of LDD is 44.23%, higher than LDH as 14.18%. L4/5 and L5/S1 are the most frequent involved segments for the majority of lumbar disc diseases. Schmorl node occurs (1.6%) more frequently in upper lumbar spine, independent of age. Modic changes (0.87%) are closely related with older age.Clinical relevanceWhen diagnosing and treating lumbar disc disease, it might be important to consider the updated nomenclature of LDD and LDH. Our study provides additional novel vision on the features of LDD and LDH in a large-scale sample based on the nomenclature of novel version.

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Section: Introductionmentioning

confidence: 99%

Identification of lumbar disc disease hallmarks: a large cross-sectional study

et al. 2016

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“…The tendon is useless after transfer. 7 When a tendon is rerouted to a new pathway, its muscle power will decrease at least one A 31-year-old man sustained poliomyelitis with shortening of right lower extremity of 4.5 cm (femur, 1.5 cm; tibia, 3.0 cm). The tibia was lengthened of 3.5 cm and ankle arthrodesis was performed.…”

Section: Discussionmentioning

confidence: 99%

Combined tibial lengthening and ankle arthrodesis for patients with certain type of sequelae of poliomyelitis

2017

J Orthop Surg (Hong Kong)

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“…The long-term outcomes for lumbar disc herniation (LDH) are generally considered favorable, and surgery is reserved for indications such as refractory pain, cauda equina syndrome, and progressive neurological deficits [1,2]. Neurological deficits, albeit uncommon, are a significant complication following LDH [3]. The severity of neurological deficits can range from weakness in an isolated myotome to cauda equina syndrome.…”

Section: Introductionmentioning

confidence: 99%

“…The severity of neurological deficits can range from weakness in an isolated myotome to cauda equina syndrome. Neurological recovery in patients with mild neurological deficits (Medical Research Council [MRC] grade >3/5) has been reported to be satisfactory, regardless of the treatment experienced (e.g., conservative vs. surgical treatment) [3]. However, progressive neurological deficits or cauda equina syndrome is considered a surgical emergency, and early surgical decompression has been recommended as the treatment of choice [4-7].…”

Section: Introductionmentioning

confidence: 99%

“…The majority of the available literature on neurological recovery following neurodeficit is limited to retrospective series [8-12]. Neurological recovery following surgical decompression is not universal, and variable recovery rates of between 61% and 88% have been reported in the literature [3]. Various factors have been postulated as affecting recovery; however, the contribution of each still remains controversial [6,9,10].…”

Section: Introductionmentioning

confidence: 99%

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Factors Affecting Early and 1-Year Motor Recovery Following Lumbar Microdiscectomy in Patients with Lumbar Disc Herniation: A Prospective Cohort Review

et al. 2019

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Study DesignProspective cohort study.PurposeThe study was aimed at evaluating clinicoradiological factors affecting recovery of neurological deficits in cases of lumbar disc herniation (LDH) treated by lumbar microdiscectomy.Overview of LiteratureThe majority of the available literature on neurological recovery following neurodeficit is limited to retrospective series. The literature is currently limited regarding variables that can help predict the recovery of neurodeficits following LDH.MethodsA prospective analysis was performed on 70 consecutive patients who underwent lumbar microdiscectomy (L1–2 to L5–S1) owing to neurological deficits due to LDH. Patients with motor power ≤3/5 in L2–S1 myotomes were considered for analysis. Follow-up was performed at 2, 6, and 12 months to note recovery of motor deficits. Clinicoradiological parameters were compared between the recovered and nonrecovered groups.ResultsA total of 65 patients were available at the final follow-up: 41 (63%) had completely recovered by 2 months; four showed delayed recovery at the 6-month follow-up; and 20 (30.7%) showed no recovery at 1 year. Clinicoradiological factors, including diabetes, complete initial deficit, areflexia, multilevel disc prolapse, longer duration since initial symptoms, and ≥2 previous symptomatic episodes were associated with a significant risk of poorer recovery (p<0.05 for all). Age, sex, occupation, smoking, level/type or location of disc herniation, primary canal stenosis, disc fragment dimensions, precipitating factors, bladder involvement, bilaterality of symptoms, and the presence or absence of anal reflex did not affect neurological recovery (p>0.05 for all). Diabetes mellitus (p=0.033) and complete initial motor deficit (p=0.028) were significantly associated with delayed recovery in the multivariate analysis.ConclusionsThe overall neurological recovery rate in our study was 69%. Diabetes mellitus (p=0.033) and complete initial motor deficit were associated with delayed motor recovery.

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Recovery of severe motor deficit secondary to herniated lumbar disc prolapse: is surgical intervention important? A systematic review

Abstract: The current available evidence is not robust enough to address the questions posed. We have proposed a framework for future studies.

Cited by 25 publications

References 22 publications

Identification of lumbar disc disease hallmarks: a large cross-sectional study

Identification of lumbar disc disease hallmarks: a large cross-sectional study

Combined tibial lengthening and ankle arthrodesis for patients with certain type of sequelae of poliomyelitis

Factors Affecting Early and 1-Year Motor Recovery Following Lumbar Microdiscectomy in Patients with Lumbar Disc Herniation: A Prospective Cohort Review

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