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

2021 ◽  
pp. 1-6
Author(s):  
Assaf Berger ◽  
Laurence Mangel ◽  
Sharif Basal ◽  
Zvi Lidar ◽  
Gilad J Regev ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Postoperative Period ◽  
Univariate Analysis ◽  
Degenerative Disease ◽  
Foot Drop ◽  
Functional Improvement ◽  
Lumbar Degenerative Disease ◽  
Motor Weakness ◽  
Short And Long Term

OBJECTIVE 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.

scholarly journals Foot Drop Caused by Lumbar Degenerative Disease: Clinical Features, Prognostic Factors of Surgical Outcome and Clinical Stage

PLoS ONE ◽  
2013 ◽  
Vol 8 (11) ◽  
pp. e80375 ◽  
Author(s):  
Kun Liu ◽  
Wei Zhu ◽  
Jiangang Shi ◽  
Lianshun Jia ◽  
Guodong Shi ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Clinical Features ◽  
Surgical Outcome ◽  
Clinical Stage ◽  
Degenerative Disease ◽  
Foot Drop ◽  
Lumbar Degenerative Disease

scholarly journals Comparison of Clinical Efficacy Between Transforaminal and Interlaminar Epidural Injections in Lumbosacral Disc Herniation: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 1 (21;1) ◽  
pp. 433-447 ◽  
Author(s):  
Jung Hwan Lee
Keyword(s):  
Systematic Review ◽  
Clinical Efficacy ◽  
Pain Control ◽  
Meta Analysis ◽  
Epidural Injection ◽  
Functional Improvement ◽  
Low Grade ◽  
Short Term ◽  
Short And Long Term

Background: Epidural injection (EI) is used to treat back or radicular pain from lumbosacral disc herniation (LDH). Although several reports have stated that the transforaminal approach in EI (TFEI) has an advantage in target specificity and yields better clinical efficacy than the interlaminar approach in EI (ILEI), other studies have indicated that the clinical efficacy of ILEI was not inferior to that of TFEI and that ILEI also has the ability to spread medication into the ventral space to a degree similar to that of TFEI. There has been controversy about whether TFEI is superior to ILEI in clinical efficacy. Objectives: This systematic review and meta-analysis aimed to investigate whether TFEI is more useful than ILEI for achieving clinical outcomes in patients with LDH. Study design: A systematic review and meta-analysis using a random effects model on randomized controlled studies (RCT). Methods: A literature search was performed in MEDLINE, EMBASE, Cochrane review, and KoreaMed for studies published from January 1996 until July 2017. From those found fulfilling the search criteria, manuscripts that compared the clinical efficacy of steroids and control agents, such as local anesthetics or saline, in terms of pain control and functional improvement were included in this study. Exclusion criteria included a previous history of lumbosacral surgery, nonspecific low back pain, severe spinal stenosis, and severe disc degeneration. After reviewing titles, abstracts, and the full text of 6,711 studies; 12 studies were included in the qualitative synthesis. Data including pain scores, functional scores, and follow-up period were extracted from 10 studies and analyzed using a random effects model to obtain effect size and its statistical significance. The quality and level of evidence were analyzed in accordance with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results: In terms of pain control, TFEI showed significantly better short-term (2 weeks to 1 month) outcomes and slightly favorable long-term (4 - 6 month) outcomes, but without significance, in comparison with ILEI. In terms of functional improvement, TFEI also showed favorable short- and long-term outcomes, but without significance, in comparison with ILEI. TFEI had target specificity, required no additional cost and resources, and had equal applicability to ILEI. However, TFEI was more associated with a higher frequency of discomfort or adverse events during the procedure. Overall, better results were reported with TFEI over ILEI, but with low-grade evidence due to the inconsistency and imprecision of the selected studies. Limitation: Analyses of safety or adverse effects could not be performed due to a lack of available data from the included studies. Conclusions: Based on low-grade evidence, TFEI showed significantly better short-term pain control and slightly favorable outcomes in long-term pain reduction and short- and long-term functional improvement in comparison with ILEI. Key words: Epidural injection, interlaminar, transforaminal, meta-analysis, systemic review, pain, function

scholarly journals Surgical Outcome for Foot Drop in Lumbar Degenerative Disease

2012 ◽  
Vol 2 (3) ◽  
pp. 125-128 ◽  
Author(s):  
Deepti Bhargava ◽  
Priyank Sinha ◽  
Saurabh Odak ◽  
Atul Tyagi ◽  
Gerry Towns ◽  
...  
Keyword(s):  
Surgical Outcome ◽  
Degenerative Disease ◽  
Foot Drop ◽  
Lumbar Degenerative Disease

The role of speech therapist in the patient care team for bariatric surgery

2020 ◽  
pp. 1-13
Author(s):  
Maiara Tomanchieviez ◽  
Tainá Viégas da Silva Garcia ◽  
Marlei Braude Canterji ◽  
Deisi Cristina Gollo Marques Vidor
Keyword(s):  
Bariatric Surgery ◽  
Postoperative Period ◽  
Speech Therapy ◽  
Positive Impact ◽  
Patient Care Team ◽  
Speech Language Pathologist ◽  
Short And Long Term ◽  
Speech Therapist

The work of the speech therapist with patients undergoing Bariatric Surgery (BS) is still little explored, although essential for the adequate preparation of the subject for surgery, as well as for his short and long term recovery. Given its importance and it’s still limited performance in this scenario, the objective of this study was to verify the perception of patients about the importance and effectiveness of speech therapy both in the pre and postoperative period of BS. Questionnaires were carried out with 44 patients divided into 4 groups, according to the moment of bariatric surgery follow-up. Most of the subjects were unaware of the role of the speech therapist at the beginning of the treatment, but they considered their guidance and their presence in the team relevant during the process. The ignorance of the role of the SpeechLanguage Pathologist in the care of bariatric patients is related to the incipient participation of Speech-Language Pathologists in this scenario. The positive impact of speech therapy guidelines in the preoperative period improves quality of life, provides information and clarifies subjects’ doubts and fears, enhancing results and minimizing postoperative problems. The professional’s guidance in relation to the aspects experienced in the patients’ daily lives implies a consensus on the importance of the participation of the Speech Therapist during the process of monitoring the BS. Patients’ perception of the importance of the guidelines received by the Speech-Language Pathologist was well-known, as well as their necessary participation in the multidisciplinary team. The results demonstrated the effectiveness of speech therapy both in the pre and in the short and long term postoperative period.

scholarly journals Flexible Stabilisation of the Degenerative Lumbar Spine Using PEEK Rods

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Jacques Benezech ◽  
Bruno Garlenq ◽  
Gilles Larroque
Keyword(s):  
Pedicle Screws ◽  
Posterior Lumbar Interbody Fusion ◽  
Degenerative Disease ◽  
High Rate ◽  
Adjacent Segment ◽  
Lumbar Degenerative Disease ◽  
Peek Rods ◽  
Adjacent Disc ◽  
Adjacent Segments

Posterior lumbar interbody fusion using cages, titanium rods, and pedicle screws is considered today as the gold standard of surgical treatment of lumbar degenerative disease and has produced satisfying long-term fusion rates. However this rigid material could change the physiological distribution of load at the instrumental and adjacent segments, a main cause of implant failure and adjacent segment disease, responsible for a high rate of further surgery in the following years. More recently, semirigid instrumentation systems using rods made of polyetheretherketone (PEEK) have been introduced. This clinical study of 21 patients focuses on the clinical and radiological outcomes of patients with lumbar degenerative disease treated with Initial VEOS PEEK®-Optima system (Innov’Spine, France) composed of rods made from PEEK-OPTIMA®polymer (Invibio Biomaterial Solutions, UK) without arthrodesis. With an average follow-up of 2 years and half, the chances of reoperation were significantly reduced (4.8%), quality of life was improved (ODI = 16%), and the adjacent disc was preserved in more than 70% of cases. Based on these results, combined with the biomechanical and clinical data already published, PEEK rods systems can be considered as a safe and effective alternative solution to rigid ones.

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