Foot drop caused by lumbar degenerative disease: clinical features, prognostic factors of surgical outcome and clinical stage

• Published in: PloS one 2013-11, Vol.8 (11), p.e80375-e80375
• Main Authors: Liu, Kun, Zhu, Wei, Shi, Jiangang, Jia, Lianshun, Shi, Guodong, Wang, Yuan, Liu, Ning
• Format: Article
• Language: English
• Subjects: Adult; Age; Back pain; Bone surgery; Compression; Cysts; Disease; Erythrocytes; Feet; Female; Hospitals; Humans; Logistic Models; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - pathology; Lumbar Vertebrae - surgery; Lymphoma; Male; Medical prognosis; Middle Aged; Muscle strength; Orthopedics; Paralysis; Patients; Radiography; Recovery; Regression analysis; Retrospective Studies; Skeletal muscle; Spinal Diseases - diagnostic imaging; Spinal Diseases - pathology; Spinal Diseases - surgery; Surgeons; Surgery; Surgical outcomes
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0080375

The 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. We 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. Foot 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. L5 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.