All Title Author
Keywords Abstract

PLOS ONE  2013 

Foot Drop Caused by Lumbar Degenerative Disease: Clinical Features, Prognostic Factors of Surgical Outcome and Clinical Stage

DOI: 10.1371/journal.pone.0080375

Full-Text   Cite this paper   Add to My Lib


Objective 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. Methods 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. Results 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. Conclusions 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.


[1]  Masakado Y, Kawakami M, Suzuki K, Abe L, Ota T et al. (2008) Clinical neurophysiology in the diagnosis of peroneal nerve palsy. Keio J Med 57: 84-89. doi:10.2302/kjm.57.84. PubMed: 18677088.
[2]  Stewart JD (2008) Foot drop: where, why and what to do? Prac Neurol 8: 158-169. doi:10.1136/jnnp.2008.149393.
[3]  Voermans NC, Koetsveld AC, Zwarts MJ (2006) Segmental overlap: foot drop in S1 radiculopathy. Acta Neurochir 148: 809-813. doi:10.1007/s00701-006-0754-0. PubMed: 16523224.
[4]  Ji JH, Shafi M, Kim WY, Park SH, Cheon JO (2007) Compressive neuropathy of the tibial nerve and peroneal nerve by a Baker's cyst: Case report. Knee 14: 249–252. doi:10.1016/j.knee.2007.01.003. PubMed: 17300942.
[5]  Bobba RK, Arsura EL, Sawh AK, Naseem M (2006) Diagnostic challenge posed by the clinical presentation of foot drop in a patient with Hodgkin's lymphoma. Eur J Intern Med 17: 572–574. doi:10.1016/j.ejim.2006.07.010. PubMed: 17142177.
[6]  Ferraresi S, Garozzo D, Bianchini E, Gasparotti R (2010) Perineurioma of the sciatic nerve: a possible cause of idiopathic foot drop in children: report of 4 cases. J Neurosurg Pediatr 6: 506-510. doi:10.3171/2010.8.PEDS10214. PubMed: 21039177.
[7]  Karao?lan A, Akdemir O, Erdo?an H, Colak A (2009) A rare emergency condition in neurosurgery: foot drop due to Paget's disease. Turk Neurosurg 19: 208-210. PubMed: 19431139.
[8]  Ahmad FU, Pandey P, Sharma BS, Garg A (2006) Foot drop after spinal anesthesia in a patient with a low-lying cord. Int J Obstet Anesth 15: 233–236. doi:10.1016/j.ijoa.2005.11.002. PubMed: 16798451.
[9]  Hans SS, Shepard AD, Reddy P, Rama K, Romano W (2011) Iatrogenic arterial injuries of spine and orthopedic operations. J Vasc Surg 53: 407-413. doi:10.1016/j.jvs.2010.08.084. PubMed: 21055898.
[10]  Okuda S, Miyauchi A, Oda T, Haku T, Yamamoto T et al. (2006) Surgical complications of posterior lumbar interbody fusion with total facetectomy in 251 patients. J Neurosurg Spine 4: 304–309. doi:10.3171/spi.2006.4.4.304. PubMed: 16619677.
[11]  Aono H, Iwasaki M, Ohwada T, Okuda S, Hosono N et al. (2007) Surgical outcome of drop foot caused by degenerative lumbar diseases. Spine 32: E262–E266. doi:10.1097/01.brs.0000251884.94821.c0. PubMed: 17426622.
[12]  Ghahreman A, Ferch RD, Rao P, Chandran N, Shadbolt B (2009) Recovery of ankle dorsiflexion weakness following lumbar decompressive surgery. J Clin Neurosci 16: 1024-1027. doi:10.1016/j.jocn.2008.10.017. PubMed: 19428255.
[13]  Girardi FP, Cammisa FP Jr, Huang RC, Parvataneni HK, Tsairis P (2002) Improvement of preoperative foot drop after lumbar surgery. J Spinal Disord Tech 15: 490–494. doi:10.1097/00024720-200212000-00010. PubMed: 12468976.
[14]  Iizuka Y, Iizuka H, Tsutsumi S, Nakagawa Y, Nakajima T et al. (2009) Foot drop due to lumbar degenerative conditions: mechanism and prognostic factors in herniated nucleus pulposus and lumbar spinal stenosis. J Neurosurg Spine 10: 260–264. doi:10.3171/2008.12.SPINE08500. PubMed: 19320587.
[15]  Campbell WW (2005) DeJong's The Neurologic Examination. Philadelphia: Lippincott Williams & Wilkin Press. 641 p.
[16]  Hoppenfeld S, Hutton R (1976) Physical Examination of the Spine and Extremities. New York: Appleton-Century Crofts Press. 276 pp.
[17]  McCulloch JA, Waddell G (1980) Variation of the lumbosacral myotomes with bony segmental anomalies. J Bone Joint Surg Br 62: 475–480. PubMed: 7430228.


comments powered by Disqus