Foot drop due to lumbar degenerative conditions: mechanism and prognostic factors in herniated nucleus pulposus and lumbar spinal stenosis

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Object

The aim of this study was to analyze the mechanism and prognostic factors of foot drop caused by lumbar degenerative conditions.

Methods

The authors retrospectively reviewed the charts of 28 patients with foot drop due to a herniated nucleus pulposus (HNP) or lumbar spinal stenosis (LSS), scoring between 0 and 3 on manual muscle testing for the tibialis anterior muscles. They analyzed the mechanism of foot drop and whether the duration before the operation, preoperative tibialis anterior and extensor hallucis longus strength, age, gender, and diabetes mellitus were all found to be prognostic factors for postoperative tibialis anterior recovery. They also investigated whether the diagnosis had any influence on the prognosis.

Results

The compression of double roots and a sequestrated fragment were observed, respectively, in 9 and 13 of 16 patients with HNP. Multiple levels including the L4–5 segment were decompressed in 8 of 12 patients with LSS. Analysis did not demonstrate any prognostic factor in surgically treated HNP, but significant associations with prognosis were observed with respect to preoperative tibialis anterior (p = 0.033) and extensor hallucis longus (p = 0.020) strength in patients with LSS. In addition, the postoperative muscle recovery in patients with HNP was significantly superior to that in patients with LSS (p = 0.011).

Conclusions

Double root compression was the most common condition associated with foot drop due to HNP. The diagnosis and preoperative tibialis anterior and extensor hallucis longus strength in LSS were factors that influenced recovery following an operation.

Abbreviations used in this paper: HNP = herniated nucleus pulposus; LSS = lumbar spinal stenosis; MMT = manual muscle testing; PLF = posterolateral fusion; TLIF = transforaminal lumbar interbody fusion.

Article Information

Address correspondence to: Yoichi Iizuka, M.D., Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan. email: yiizuka@med.gunma-u.ac.jp.

© AANS, except where prohibited by US copyright law.

Headings

References

1

Andersson HCarlsson CA: Prognosis of operatively treated lumbar disc herniations causing extensor paralysis. Acta Chir Scand 132:5015061966

2

Aono HIwasaki MOhwada TOkuda SHosono NFuji T: Surgical outcome of drop foot caused by degenerative lumbar diseases. Spine 32:E262E2662007

3

Baysefer AErdogan ESail ASirin SSeber N: Foot drop following brain tumors: case reports. Minim Invasive Neurosurg 41:97981998

4

Chang HSNakagawa H: Altered function of lumbar nerve roots in patients with transitional lumbosacral vertebrae. Spine 29:163216352004

5

Engsberg JRLauryssen CRoss SAHollman JHWalker DWippold FJ II: Spasticity, strength, and gait changes after surgery for cervical spondylotic myelopathy: a case report. Spine 28:E136E1392003

6

Eskandary HHamzei AYasamy MT: Foot drop following brain lesion. Surg Neurol 43:89901995

7

Frymoyer JWWiesel SW: The Adult and Pediatric Spine ed 3PhiladelphiaLippincott Williams & Wilkins2004

8

Garrido ERosenwasser R: Painless foot drop secondary to lumbar disc herniation: report of two cases. Neurosurgery 8:4844861981

9

Gilchrist RVBhagia SMLenrow DAChou LHChow DSlipman CW: Painless foot drop: an atypical etiology of a common presentation. Pain Physician 5:4194212002

10

Girardi FPCammisa FPHuang RCParvataneni HKTsairis P: Improvement of preoperative foot drop after lumbar surgery. J Spinal Disord Tech 15:4904942002

11

Guigui PBenoist MDelecourt CDelhoume JDeburge A: Motor deficit in lumbar spinal stenosis: a retrospective study of a series of 50 patients. J Spinal Disord 11:2832881998

12

Hoppenfeld SHutton R: Physical Examination of the Spine and Extremities New YorkAppleton-Century Crofts1976

13

Katirji MBWilbourn AJ: Common peroneal mononeuropathy: a clinical and electrophysiologic study of 116 lesions. Neurology 38:172317281988

14

McCulloch JAWaddell G: Variation of the lumbosacral myotomes with bony segmental anomalies. J Bone Joint Surg Br 62:4754801980

15

Pritchett JW: Lumbar decompression to treat foot drop after hip arthroplasty. Clin Orthop Relat Res 303:1731771994

16

Saal JA: Natural history and nonoperative treatment of lumbar disc herniation. Spine 21:24 Suppl291996

17

Takino TNaka KOkamoto SHashimoto N: [A study of drop foot due to lumbar lesion.]. Seikei Geka 51:3863912000. (Jpn)

18

Tokuhashi YMatsuzaki HUematsu YOda H: Symptoms of thoracolumbar junction disc herniation. Spine 26:E512E5182001

19

Van der Salm ANene AVMaxwell DJVeltink PHHermens HJIjzerman MJ: Gait impairments in a group of patients with incomplete spinal cord injury and their relevance regarding therapeutic approaches using functional electrical stimulation. Artif Organs 29:8142005

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