J Neurosurg Spine 42:727–736, 2025
This multicenter retrospective study of 75 patients found that prompt surgical intervention for unilateral painful foot drop due to lumbar disc herniation improves outcomes, especially in younger and less frail patients. Delays in surgery reduced the likelihood of recovery, but no specific timing cutoff was identified.
• This multicenter retrospective study analyzed surgical outcomes for unilateral painful foot drop caused by lumbar disc herniation, excluding cauda equina syndrome cases.
• 75 adult patients were included; improvement in muscle strength (MRC grade) was seen in 55%, with 23% achieving full resolution of foot drop.
• Earlier surgery, younger age, and lower frailty scores were associated with better outcomes; for each day surgery was delayed, chance of improvement dropped by 0.2%.
• No specific surgical timing cutoff was identified, but delays reduced likelihood of recovery.
• Patients with more severe initial weakness (lower MRC grade) were more likely to show some improvement, but less likely to achieve full resolution.
• Radicular pain (sciatica) improved in most patients regardless of time to surgery.
• Study limitations include small sample size, retrospective design, and variability between centers.
• Authors recommend early surgical consideration and call for larger prospective studies to refine guidelines.
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