Jun Ma1, Yunfei He2, An Wang3, Weiheng Wang1, Yanhai Xi1, Jiangming Yu4, Xiaojian Ye5. 1. Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China. 2. Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China; Department of Spinal Surgery, Lanzhou General Hospital of Lanzhou Military Command Region, Lanzhou, PR China. 3. Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China; Department of Orthopaedics, Shanghai Armed Police Force Hospital, Shanghai, PR China. 4. Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China. Electronic address: yjm_spine@smmu.edu.cn. 5. Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China. Electronic address: xjyespine@smmu.edu.cn.
Abstract
OBJECTIVES: To identify the risk factors for foot drop in patients with lumbar disc herniation (LDH). METHODS: Two hundred thirty-six patients who underwent surgery for LDH were retrospectively reviewed. Foot drop was defined as tibialis anterior muscle strength of lower than grade 4 by the manual muscle test. Possible risk factors, including demographic and radiographic parameters, were evaluated by multivariate logistic regression analysis. RESULTS: Fifty-two patients (22.9%) suffered from foot drop. Multivariate logistic regression analysis revealed that diabetes mellitus, disc calcification, patients who had an acute episode or acute-on-chronic episode, and patients who presented with lateral recess or extraforaminal type of disc herniation were at greater risk of foot drop. Notably, patients who had a canal occupancy rate of more than 50% were at greater risk of foot drop compared with patients who had a canal occupy rate of less than 25%. With a 1.0-mm increase in anteroposterior diameter of the index spinal canal, the risk of developing foot drop decreased to 51.8% in these patients (P < 0.05). CONCLUSIONS: The following factors may affect the development of foot drop in patients with LDH: 1) diabetes mellitus; 2) patients with an acute episode or acute-on-chronic episode; 3) patients with lateral recess or foraminal type of herniation; 4) disc calcification; 5) canal occupancy rate greater than 50%; and 6) the anteroposterior diameter of canal. Surgical treatments for patients with those risk factors should be implemented positively during the follow-up period to reduce possible adverse outcomes.
OBJECTIVES: To identify the risk factors for foot drop in patients with lumbar disc herniation (LDH). METHODS: Two hundred thirty-six patients who underwent surgery for LDH were retrospectively reviewed. Foot drop was defined as tibialis anterior muscle strength of lower than grade 4 by the manual muscle test. Possible risk factors, including demographic and radiographic parameters, were evaluated by multivariate logistic regression analysis. RESULTS: Fifty-two patients (22.9%) suffered from foot drop. Multivariate logistic regression analysis revealed that diabetes mellitus, disc calcification, patients who had an acute episode or acute-on-chronic episode, and patients who presented with lateral recess or extraforaminal type of disc herniation were at greater risk of foot drop. Notably, patients who had a canal occupancy rate of more than 50% were at greater risk of foot drop compared with patients who had a canal occupy rate of less than 25%. With a 1.0-mm increase in anteroposterior diameter of the index spinal canal, the risk of developing foot drop decreased to 51.8% in these patients (P < 0.05). CONCLUSIONS: The following factors may affect the development of foot drop in patients with LDH: 1) diabetes mellitus; 2) patients with an acute episode or acute-on-chronic episode; 3) patients with lateral recess or foraminal type of herniation; 4) disc calcification; 5) canal occupancy rate greater than 50%; and 6) the anteroposterior diameter of canal. Surgical treatments for patients with those risk factors should be implemented positively during the follow-up period to reduce possible adverse outcomes.
Authors: Anne Elisabeth Carolus; Michael Becker; Jeanne Cuny; Rüdiger Smektala; Kirsten Schmieder; Christopher Brenke Journal: Dtsch Arztebl Int Date: 2019-05-17 Impact factor: 5.594