Tag: foot drop

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Surgical outcomes of unilateral painful foot drop secondary to lumbar disc herniation

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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Predictors of functional recovery following surgery for foot drop due to degenerative lumbar disease

Surgery for foot drop secondary to lumbar degenerative disease is not always associated with postoperative functional improvement. It is still unclear whether early decompression results in better functional recovery and how soon surgery should be performed. This study aimed to evaluate predicting factors that affect short- and long-term recovery outcomes and to explore the relationship between timing of lumbar decompression and recovery from foot drop in an attempt to identify a cutoff time from symptom onset until decompression for optimal functional improvement.

METHODS The authors collected demographic, clinical, and radiographic data on patients who underwent surgery for foot drop due to lumbar degenerative disease. Clinical data included tibialis anterior muscle (TAM) strength before and after surgery, duration of preoperative motor weakness, and duration of radicular pain until surgery. TAM strength was recorded at the immediate postoperative period and 1 month after surgery while long-term follow-up on functional outcomes were obtained at ≥ 2 years postsurgery by telephone interview. Data including degree and duration of preoperative motor weakness as well as the occurrence of pain and its duration were collected to analyze their impact on short- and long-term outcomes.

RESULTS The majority of patients (70%) showed functional improvement within 1 month postsurgery and 40% recovered to normal or near-normal strength. Univariate analysis revealed a trend toward lower improvement rates in patients with preoperative weakness of more than 3 weeks (33%) compared with patients who were operated on earlier (76.5%, p = 0.034). In a multivariate analysis, the only significant predictor for maximal strength recovery was TAM strength before surgery (OR 6.80, 95% CI 1.38–33.42, p = 0.018). Maximal recovery by 1 month after surgery was significantly associated with sustained long-term functional improvement (p = 0.006).

CONCLUSIONS Early surgery may improve the recovery rate in patients with foot drop caused by lumbar degenerative disease, yet the strongest predictor for the extent of recovery is the severity of preoperative TAM weakness. Maximal recovery in the short-term postoperative period is associated with sustained long-term functional improvement and independence.

 

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