Surgical Outcome of Drop Foot Caused by Degenerative Lumbar Diseases

Aono, Hiroyuki; Iwasaki, Motoki; Ohwada, Tetsuo; Okuda, Shujiro; Hosono, Noboru; Fuji, Takeshi; Yoshikawa, Hiroyuki

doi:10.1097/01.brs.0000259922.82413.72

Cited by 92 publications

(93 citation statements)

References 12 publications

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“…More than half (55.6%; 5 of 9 patients) the patients with preoperative drop foot showed residual gait disturbance (Table 2). A previous study on the surgical outcome of LSS patients with drop foot revealed that especially those with a preoperative MMT score of 0 or 1 for ankle dorsiflexion exhibited poor alleviation of this disorder [1]. In the present study as well, there were three patients with an MMT score of 0 or 1, and all of them showed residual gait disturbance due to the unchanged drop foot (data not shown).…”

Section: Discussionmentioning

confidence: 51%

“…In fact, a prospective study revealed that the surgery generally resulted in a more preferable greater outcome than non-surgical treatments in the LSS patients [20]. However, about 20-40% of patients have been reported to be dissatisfied with the result due to residual symptoms [1,8,9]. To avoid the discrepancy between a patient's expectations and actual surgical outcome, a surgeon should preoperatively inform the patient in detail of the possible post-surgery outcome of the major symptoms such as leg pain/numbness and gait disturbance.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of residual symptoms in lower extremities after decompression surgery on lumbar spinal stenosis

et al. 2010

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Leg pain/numbness and gait disturbance, two major symptoms in the lower extremities of lumbar spinal stenosis (LSS), are generally expected to be alleviated by decompression surgery. However, the paucity of information available to patients before surgery about specific predictors has resulted in some of them being dissatisfied with the surgical outcome when the major symptoms remain after the procedure. This prospective, observational study sought to identify the predictors of the outcome of a decompression surgery: modified fenestration with restorative spinoplasty. Of 109 consecutive LSS patients who underwent the decompression surgery, 89 (56 males and 33 females) completed the 2 year follow-up. Both leg pain/numbness and gait disturbance determined by the Japanese Orthopedic Association scoring system were significantly improved at 2 years after surgery compared to those preoperative, regardless of potential predictors including gender, preoperative presence of resting numbness in the leg, drop foot, cauda equina syndrome, degenerative spinal deformity or myelographic filling defect, or the number of decompressed levels. However, 27 (30.3%) and 13 (14.6%) patients showed residual leg pain/numbness and gait disturbance, respectively. Among the variables examined, the preoperative resting numbness was associated with residual leg pain/ numbness and gait disturbance, and the preoperative drop foot was associated with residual gait disturbance, which was confirmed by logistic regression analysis after adjustment for age and gender. This is the first study to identify specific predictors for these two remaining major symptoms of LSS after decompression surgery, and consideration could be given to including this in the informed consent.

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Section: Discussionmentioning

confidence: 51%

Section: Introductionmentioning

confidence: 99%

Predictors of residual symptoms in lower extremities after decompression surgery on lumbar spinal stenosis

et al. 2010

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“…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%

“…Tibialis anterior muscle strength was evaluated using a manual muscle test according to the Medical Research Council scale and as described in a previous study (Table 1) [1]. Drop foot was defined as a tibialis anterior muscle strength score less than 3 (of 5) [1,2,6,8].…”

Section: Clinical Assessmentmentioning

confidence: 99%

“…In previous studies that investigated predictors of residual drop foot (such as the duration of drop foot before surgery, and preoperative weakness of ankle dorsiflexors), multivariate logistic regression analyses were used to reinforce the results of univariate analyses [1,3,16,21]. However, logistic regression analyses have several disadvantages in terms of interpreting results.…”

Section: Introductionmentioning

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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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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Surgical Outcome of Drop Foot Caused by Degenerative Lumbar Diseases

Abstract: Palsy duration and preoperative strength were factors that most affected drop foot recovery following surgical intervention for spinal degeneration.

Cited by 92 publications

References 12 publications

Predictors of residual symptoms in lower extremities after decompression surgery on lumbar spinal stenosis

Predictors of residual symptoms in lower extremities after decompression surgery on lumbar spinal stenosis

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

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