Surgical Outcomes for Painless Drop Foot Due to Degenerative Lumbar Disorders

Aono, Hiroyuki; Nagamoto, Yukitaka; Tobimatsu, Hidekazu; Takenaka, Shota; Iwasaki, Motoki

doi:10.1097/bsd.0000000000000102

Cited by 20 publications

(25 citation statements)

References 15 publications

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“…Prior work using traditional analytic approaches (such as multivariate analyses) have suggested that duration of drop foot before surgery and preoperative motor weakness [1,3,16,17] may be associated with recovery of active dorsiflexion after decompressive lumbar spine surgery; however, this is somewhat controversial, since other studies did not identify one or either of these factors as important in anticipating a patient's neurologic recovery [2,6,7,12,13,21]. We believe that those analytic approaches may not be ideal for this purpose because they are difficult to describe layered correlations among predictors, and we believe that Bayesian network analysis, which is graphic and intuitive to the clinician, may be better suited to the task because this approach readily describes the layered correlation among predictors.…”

Section: Discussionmentioning

confidence: 83%

“…Predictors for residual drop foot in previous studies are varied, but the two main predictors have been preoperative motor weakness [1,3,6,12,16,17,21] and the duration of drop foot before surgery [2,3,7,16,17]. The former corresponds to pretibialis anterior muscle strength in the current study.…”

Section: Discussionmentioning

confidence: 99%

“…Posttibialis anterior strength of 3 or greater was used to access minimal recovery from drop foot, which corresponds to a ''good'' outcome, and posttibialis anterior strength of 4 or greater was considered an ''excellent'' outcome in previous studies [1,2].…”

Section: Candidate Variables and Outcomesmentioning

confidence: 99%

“…Drop foot was defined as a tibialis anterior muscle strength score less than 3 (of 5) [1,2,6,8]. Tibialis anterior muscle strength was graded as 3-when patients could dorsiflex and invert their ankles while they were seated but could not achieve full ROM.…”

Section: Clinical Assessmentmentioning

confidence: 99%

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

Takenaka

Aono

2017

Clinical Orthopaedics &Amp; Related Research

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Background Drop foot resulting from degenerative lumbar diseases can impair activities of daily living. Therefore, predictors of recovery of this symptom have been investigated using univariate or/and multivariate analyses. However, the conclusions have been somewhat controversial. Bayesian network models, which are graphic and intuitive to the clinician, may facilitate understanding of the prognosis of drop foot resulting from degenerative lumbar diseases. Questions/purposes (1) To show a layered correlation among predictors of recovery from drop foot resulting from degenerative lumbar diseases; and (2) to develop support tools for clinical decisions to treat drop foot resulting from lumbar degenerative diseases.Methods Between 1993 and 2013, we treated 141 patients with decompressive lumbar spine surgery who presented with drop foot attributable to degenerative diseases. Of those, 102 (72%) were included in this retrospective study because they had drop foot of recent development and had no diseases develop that affect evaluation of drop foot after surgery. Specifically, 28 (20%) patients could not be analyzed because their records were not available at a minimum of 2 years followup after surgery and 11 (8%) were lost owing to postoperative conditions that affect the muscle strength evaluation. Eight candidate variables were sex, age, herniated soft disc, duration of the neurologic injury (duration), preoperative tibialis anterior muscle strength (pretibialis anterior), leg pain, cauda equina syndrome, and number of involved levels. Manual muscle testing was used to assess the tibialis anterior muscle strength. Drop foot was defined as a tibialis anterior muscle strength score of less than 3 of 5 (5 = movement against gravity and full resistance, 4 = movement against gravity and moderate resistance, 3 = movement against gravity through full ROM, 3À = movement against gravity through partial ROM, 2 = movement with gravity eliminated through full ROM, 1 = slight contraction but no movement, and 0 = no contraction). The two outcomes of interest were postoperative tibialis anterior muscle strength (posttibialis anterior) of 3 or greater and posttibialis anterior strength of 4 or greater at 2 years after surgery. We developed two separate Bayesian network models with outcomes of interest for posttibialis anterior strength of 3 or greater and posttibialis anterior strength of 4 or greater. The two outcomes correspond to ''good'' and ''excellent'' results based on previous reports, respectively. Direct predictors are defined as variables that have the tail of the arrow connecting the outcome of interest, whereas indirect predictors are defined as variables that have the tail of the arrow Each author certifies that neither he, nor any member of his immediate family, have funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for ...

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Candidate Variables and Outcomesmentioning

confidence: 99%

Section: Clinical Assessmentmentioning

confidence: 99%

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

Takenaka

Aono

2017

Clinical Orthopaedics &Amp; Related Research

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“…An arising problem in this pathway is being unable to move the extremities, which is called paresis. Isolated foot drop of a single leg is the weakness of the dorsiflexor muscles of the foot, and this usually arises painlessly due to peripheral neuropathy, such as peroneal nerve damage or radiculopathy 1 7) . Isolated painless foot drop is also caused by central origin, but this is rare, and there are only several reports of acute infarction mimicking peroneal neuropathy 4 5 9 10) .…”

Section: Discussionmentioning

confidence: 99%

Isolated Painless Foot Drop due to Cerebral Infarction Mimicking Lumbar Radiculopathy: A Case Report

Kim

Yoon

2015

Korean J Spine

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Although they usually originate from peripheral problems, foot drop is caused by lesions affecting the neural pathway related to dorsiflexor muscles, whether of central or peripheral origin. We present a patient with sudden isolated foot drop caused by a small infarct in the primary motor cortex mimicking a peripheral origin. This report indicates that patients presenting isolated foot drop should be managed carefully and the possibility of both central and peripheral causes should be considered. To our knowledge, this is the first report of sudden isolated foot drop caused by a cortical infarction mimicking lumbar radiculopathy.

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Foot Drop

Tolias¹,

Giamouriadis²,

Hogg³

et al. 2018

Neurosurgery

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Surgical Outcomes for Painless Drop Foot Due to Degenerative Lumbar Disorders

Abstract: Duration of palsy had the greatest effect on recovery. As the only goal of this surgery is improvement in the strength of the tibialis anterior, caution must be exercised when considering surgery for patients with longstanding palsy.

Cited by 20 publications

References 15 publications

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

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

Isolated Painless Foot Drop due to Cerebral Infarction Mimicking Lumbar Radiculopathy: A Case Report

Foot Drop

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