Recovery of motor deficits after microdiscectomy for lumbar disc herniation

Abstract

We have studied, prospectively, 116 patients with motor deficits associated with herniation of a lumbar disc who underwent microdiscectomy. They were studied during the first six months and at a mean of 6.4 years after surgery. Before operation, muscle weakness was mild (grade 4) in 67% of patients, severe (grade 3) in 21% and very severe (grade 2 or 1) in 12%. The muscle which most frequently had severe or very severe weakness was extensor hallucis longus, followed in order by triceps surae, extensor digitorum communis, tibialis anterior, and others. At the latest follow-up examination, 76% of patients had complete recovery of strength. Persistent weakness was found in 16% of patients who had had a mild preoperative deficit and in 39% of those with severe or very severe weakness. Muscle strength was graded 4 in all patients with persistent weakness, except for four with a very severe preoperative deficit affecting the L5 or S1 nerve root. They showed no significant recovery. Excluding this last group, the degree of recovery of motor function was inversely related to the preoperative severity and duration of muscle weakness. The patients’ subjective functional capacity was not directly related to the degree of recovery except in those with persistent severe or very severe deficit.

Recovery of muscle strength after microdiscectomy for lumbar disc herniation: a prospective cohort study with 1-year follow-up

“…The recovery rate was similar to the results published earlier [2,6,19,20]. Previous studies evaluating more severe paresis (grade 3 or worse) show similar associations between the severity of paresis and the recovery rate [5,7,21].…”

“…The clinical information obtained by manual testing are not inferior to those given by EMG [7], provided that the assessment of muscle strength is made using standard methods. We followed the principle of Daniels and Worthingham's muscle testing [8].…”

“…However in clinical practice, limb paresis is a frequent additional symptom to pain [4][5][6][7], and for the patients, a major concern remains: ''What are the chances that my muscle strength will recover after surgery?''. The aim of this study is to give an answer to this question.…”

Prediction of Postoperative Clinical Recovery of Drop Foot Attributable to Lumbar Degenerative Diseases, via a Bayesian Network

“…In previous studies that investigated predictors of residual drop foot (such as the duration of drop foot before surgery, and preoperative weakness of ankle dorsiflexors), multivariate logistic regression analyses were used to reinforce the results of univariate analyses [1,3,16,21]. However, logistic regression analyses have several disadvantages in terms of interpreting results.…”

Is the lasègue sign a predictor of outcome in lumbar disc herniation surgery?

“…4,5 Likewise, surgical outcome is not consistently related to the severity of the presenting neurological impairment. [6][7][8] Clinical history and physical examination are important to guide decisions about imaging, laboratory tests, need for referral to a specialist and avoiding unnecessary surgical interventions. [9][10][11] Knowledge of prognostic factors in LDH surgery is crucial, since the indication for surgery should be reevaluated if a patient presents predictors of poor outcome.…”