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 ankle dorsiflexion weakness following lumbar decompressive surgery

“…25 However, other authors suggest a correlation between the duration of the palsy and the recovery of ADF weakness. 26,27 Several factors may explain the lack of a correlation between the duration of ADF weakness and recovery observed in our study. First, the overall duration of the weakness is determined from the clinical history.…”

“…A complete recovery of the deficit was observed in 76% of the patients. 26 A recent report by Aono et al included patients with tibialis anterior MRCS grades 3 or less, and documented an excellent result (MRCS grades 4 and 5) in 41%. No improvement was seen in 28% of the patients.…”

“…[19][20][21][22] Some publications describe the natural history and patterns of neural compression in patients with ADF weakness due to lumbar compressive pathology and only a few articles specifically evaluate the recovery of ADF weakness after decompressive surgical intervention. [23][24][25][26][27] In the current study we aimed to assess the rate and extent of the recovery of ADF weakness after surgical decompression. We reviewed demographic and clinical factors to identify those factors that predicted a better outcome.…”

Surgical Outcome of Drop Foot Caused by Degenerative Lumbar Diseases

“…Postacchini et al 14 reported an inverse relationship between the severity of the preoperative motor deficit and ability to recover complete motor function in contrast to the findings of Girardi et al 13 In the current study, we have found improved surgical outcome in the patients with shorter duration of palsy and higher strength of tibialis anterior, which supports the results of Postacchini et al, 14 and all patients who had completely recovered had palsy for 3 months or less, but there was a patient who had a 4-day duration of drop foot who did not recover at all.…”

Schmerztopik bei lumbalen Bandscheibenschäden

“…Postachini wiederum hält eine eindeutige Rückgang motorischer Defizite nach Mikrodiskektomie fest. Er betont jedoch auch, dass der OP-Erfolg von dem präoperativen Grad der Muskelschwäche abhängt [82].…”