Foot drop as the initial symptom caused by thoracic disc herniation

Eur Spine J. 2022 Jul;31(7):1795-1801. doi: 10.1007/s00586-022-07254-3. Epub 2022 May 22.

Abstract

Background: Foot drop is a syndrome resulting from weakness or paralysis of the tibialis anterior muscle. Some patients with thoracic disc herniation seek medical help complain of foot drop as the initial symptom. The study investigated the clinical characteristics of these patients and clarified the clinical efficacy after treatment.

Methods: A total of 13 patients with foot drop as the initial symptom arising from thoracic disc herniation were collected from January 2015 to December 2020. The average follow-up period was 20.5 months. We recorded neurological functions, the tibialis anterior muscle strength, Japanese Orthopedic Association score (JOA), location of the lesion, and occupation rate of herniation in the spinal canal preoperatively and at the final follow-up.

Results: None pathological reflex was found in the patients. Surgical treatment was performed in 12 of the 13 patients, and tibialis anterior functional recovery was observed in 83.4% (10/12) of the cases, with an average recovery rate of 52.8 ± 18.5%. The mean JOA score increased from 6.8 ± 1.9 points preoperatively to 8.9 ± 1.3 points postoperatively (p < 0.05), achieving a mean recovery rate of 52.3 ± 13.1%. The MRI showed the conus medullaris was obviously compressed at the level of T11-L1, and the occupation rate of herniation was more than 40% in all patients, with an average of 65.4 ± 16.3%. CT indicated that 84.6% of the cases had calcification in intervertebral discs.

Conclusion: Foot drop can be the initial symptom caused by thoracic disc herniation at the T11-L1 level, especially for the calcified disc herniation. A satisfactory recovery rate can be achieved by surgical decompression with fixation.

Keywords: Decompression; Disc herniation; Foot drop; Thoracic vertebra.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Decompression, Surgical / methods
  • Humans
  • Intervertebral Disc Displacement* / complications
  • Intervertebral Disc Displacement* / diagnostic imaging
  • Intervertebral Disc Displacement* / surgery
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / pathology
  • Lumbar Vertebrae / surgery
  • Peroneal Neuropathies* / pathology
  • Peroneal Neuropathies* / surgery
  • Retrospective Studies
  • Treatment Outcome