Surgical outcomes of unilateral painful foot drop secondary to lumbar disc herniation: a multicenter retrospective study.
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Baig Mirza Asfand, Vastani Amisha, Fayez Feras, Suvarna Rishabh, El Sheikh Mustafa, Sharma Chaitanya, Velicu Maria Alexandra, Rowland David, Trindade Jandira, Toescu Sebastian M, Murphy Suzanne M, Jindal Malaika, Reischer Gerda, Corr Paula, Nolan Deirdre, Sims-Williams Alice, Read Charlotte, Goonewardena Eranga, Johani Nabilah, Syrris Christoforos, Pandit Anand S, Rashed Sami, Khoja Abbas Khizar, Matloob Samir, Bull Jonathan, Montgomery Alexander, Moran Catherine, Sayal Parag, Hassan Samih, Okasha Mohamed, Nader-Sepahi Ali, Malik Irfan, Arvin Babak, Sadek Ahmed-Ramadan, Grahovac Gordan
Аннотация
METHODS: This retrospective study spanned 7 centers, focusing on adult patients who underwent lumbar discectomies from September 2011 to September 2022 due to painful unilateral foot drop (Medical Research Council [MRC] grade ≤ 3). Clinical records were analyzed to identify patients matching the inclusion criteria, with data collection adhering to PROCESS guidelines. Outcomes were assessed based on the MRC scale for muscle strength, and statistical analysis was conducted to determine outcome predictors.
RESULTS: This study included 75 patients (mean age 49.03 years, 1:1.007 male/female ratio). Early surgery in younger and less frail patients was associated with better outcomes, with no precise surgical timing cutoff identified. Improvement in MRC grades was seen in 41 patients (55%), with no change in 23 patients (31%) and worsening grades in 11 patients (15%). For every day delaying surgery, the likelihood of improvement decreased by 0.2%. The severity of foot drop was associated with a reduced likelihood of complete resolution, although some recovery was demonstrated. Functional recovery was consistently higher in patients with higher presenting MRC grades. Radicular pain consistently improved following surgical intervention irrespective of all other analyzed metrics.
CONCLUSIONS: Prompt surgical intervention for patients with foot drop improved outcomes, especially in those who were younger and less frail. While the study did not identify a specific cutoff for the timing of surgery, the findings emphasize the importance of early surgical consideration as delays were associated with reduced likelihood of recovery. Future research should focus on prospective studies to validate these findings and refine guidelines for surgical intervention in this patient population.