Drop foot due to lumbar degenerative disease: Painless drop foot is difficult to recover

Giant Meningioma Diagnosis and Clinical Treatment: A Case Report

This case report shows the importance of semiology during a clinical examination not only to diagnose spine clinical symptoms but also to review the central nervous system tumor as a foot drop cause. We report a unique case of a patient who consulted for constant progressive numbness and motor symptoms in the right lower extremity. Lumbar CT and MRI were negative for acute or chronic lumbar pathology. This is a 41-year-old female patient with a history of eight-month progressive right leg weakness. The physical examination did not reveal neurological alterations besides foot drop. MRI and lumbar X-rays showed no significant findings. Electromyography (EMG) indicated right peroneal neuropathy. Based on these findings, surgical treatment was not indicated; therefore, physical therapy and a referral to neurology were indicated. However, symptoms increased, resulting in a right lower extremity hemiparesis. A brain MRI showed a left frontoparietal giant meningioma, which was surgically resected after embolization. The patient evolved with a full recovery of the right-sided hemiparesis after surgery. Our case highlights the foot drop's multiple etiologies. Initially, a lumbar disc hernia was suspected, but it was ruled out by imaging studies. Later, the EMG revealed peroneal neuropathy, leading to a neurology consult. Unexpectedly, a giant intracranial meningioma was found, a rare case of foot drop. A consideration of upper motor neuron (UMN) and lower motor neuron (LMN) syndromes aided diagnosis. Tumoral resection with embolization resulted in significant improvement, showcasing the complexities of such cases. Foot drop is a peculiar clinical manifestation that must have an integral assessment to rule out peripheral and central causes. Even rare, giant meningiomas can cause focalized symptoms such as foot drop. Therefore, the assessment of foot drop should include the CT and MRI of the central nervous system.

Factors associated with improvement in tibialis anterior weakness due to lumbar degenerative disease

BACKGROUND

The weakness of the tibialis anterior remains to be a controversial topic. There has been no study that used electrophysiological assessment of the function of the lumbar and sacral peripheral motor nerves. The aim is to evaluate surgical outcomes in patients with weakness of the tibialis anterior using neurological and electrophysiological assessments.

METHODS

We enrolled 53 patients. Tibialis anterior weakness was quantified by muscle strength, as assessed using a manual muscle test on a scale of 1 through 5, with scores <5 indicating weakness. Postoperative improvement in muscle strength was classified as excellent (5 grades recovered), good (more than one grade recovered), or fair (less than one grade recovered).

RESULTS

Surgical outcomes for tibialis anterior function were categorized as "excellent" in 31, "good" in 8, "fair" in 14 patients. Significant difference in outcomes were observed depending on diabetes mellitus status, type of surgery, and the compound muscle action potentials amplitudes of the abductor hallucis and extensor digitorum brevis (p < 0.05). Surgical outcomes were classified into two groups, patients with excellent and good outcomes (Group 1) and patients with fair outcome (Group 2). Using the forward selection stepwise method, sex and the compound muscle action potentials amplitudes of the extensor digitorum brevis were identified as significant factors for their positive association with Group 1 status. The diagnostic power of the predicted probability was as high as 0.87 in terms of area under curve of the receiver operating characteristic curve.

CONCLUSIONS

There was a significant correlation between the prognosis of tibialis anterior weakness and sex and the compound muscle action potentials amplitude of extensor digitorum brevis, suggesting that recording the compound muscle action potentials amplitude of extensor digitorum brevis will aid the outcome assessment of future surgical interventions for tibialis anterior weakness.

Rehabilitation of a Patient With D12 Wedge Compression Fracture and Bilateral Foot Drop With Spinal Fusion and Posterior Decompression: A Case Report

Vertebral fracture (VF) is one of the most common injuries seen in individuals with osteoporosis, especially in post-menopausal females. There is an increase in bone resorption rate, leading to the destruction of the microarchitecture of bone. A 67-year-old female patient diagnosed with wedge compression fracture of the D12 vertebra, mild compression of the spinal cord, and bilateral foot drop came to a tertiary care hospital, where she underwent spinal fusion at the D11-L1 level and posterior decompression, after which she was referred to physiotherapy, where a patient-tailored treatment protocol was made and implemented over three weeks. Outcome measures like the visual analog scale (VAS), functional independence measure (FIM), and Oswestry's low back disability questionnaire were recorded before and after rehabilitation, and improvement in pain and activities of daily living (ADL) was found. The patient needed mild assistance. There was also improvement in the range and strength of the lower limb muscles. This case report aims to provide a comprehensive treatment protocol for a post-operative spinal fusion and bilateral foot drop patient.

A meta-analysis of prognostic factors in surgical treatment of foot drop due to lumbar degenerative diseases

Objective

Lumbar decompression surgery is an effective treatment for foot drop caused by LDD, but there is controversy about the prognostic factors affecting its efficacy. This study aimed to investigate the factors influencing the surgical outcome of foot drop due to LDD.

Methods

A systematic database search of PubMed, Embase, Web of Science, Cochrane Library and Clinical Trials was performed for relevant articles published until May 2022. Two reviewers independently screened the literature, extracted data, and evaluated the quality of the studies based on the inclusion and exclusion criteria. The quality of the studies was evaluated using the Newcastle-Ottawa Scale (NOS), and STATA 16.0 software was used for meta-analysis.

Results

A total of 730 relevant articles were initially identified and 9 articles were finally included in this study for data extraction and mea-analysis. The results of metaanalysis showed that patients with preoperative moderate muscle strength (2-3/5 on the Medical Research Council scale) had better prognosis compared to those with severe muscle weakness. Additionally, the presence of diabetes mellitus was associated with a poorer prognosis for patients with foot drop due to LDD. The OR values (95%CI) of these two factors were 5.882 (4.449, 7.776) and 5.657 (2.094,15.280) respectively.

Conclusions

Patients with moderate muscle strength have a better prognosis compared to those with severe muscle weakness. The presence of diabetes mellitus is associated with a poorer prognosis for patients with foot drop due to LDD. These factors should be considered when predicting the surgical outcome of foot drop due to LDD.

Management strategies for the painless foot drop: a systematic review of the literature

PURPOSE

Foot drop can uncommonly be a painless presenting symptom of degenerative spinal disorders. This systematic review aimed to summarise the literature on the management and outcomes of patients with a painless foot drop.

METHODS

We performed a systematic review of PubMed, EMBASE and Medline according to PRISMA guidelines. All studies published after 1980 in English referring to adult patients with a painless foot drop were included. Exclusion criteria included opinion based reports, review articles and articles in which foot drop was not caused by degenerative pathology of the thoracolumbar spine.

RESULTS

Of 62 included patients, 30 (48.4%) were male with an average age of 48.7 years (range 27-84). The mean duration of symptoms was 69.0 days (1-700). 98.8% were managed operatively. 46 (74.2%) patients had symptomatic improvement, with 41 (66.1%) having a post-intervention MRC power grading of 3 or above. Patients with a pre-procedure MRC 0 had a higher median increase in MRC post-procedure than those with MRC > 0. Of two studies comparing painful and painless symptoms, painless foot drop patients were less likely to recover to MRC equal to or over 3 than those with painful symptoms OR 0.31 (95% CI 0.04-2.65).

CONCLUSION

This systematic review and meta-analysis demonstrates a role for surgery in facilitating the neurological recovery of patients with a painless foot drop. Large randomised controlled studies are required to characterise the role of operative intervention in these patients and compare outcomes between patients with painless and painful foot drop.

Time-course gait pattern analysis in a rat model of foot drop induced by ventral root avulsion injury

Foot drop is a common clinical gait impairment characterized by the inability to raise the foot or toes during walking due to the weakness of the dorsiflexors of the foot. Lumbar spine disorders are common neurogenic causes of foot drop. The accurate prognosis and treatment protocols of foot drop are not well delineated in the scientific literature due to the heterogeneity of the underlying lumbar spine disorders, different severities, and distinct definitions of the disease. For translational purposes, the use of animal disease models could be the best way to investigate the pathogenesis of foot drop and help develop effective therapeutic strategies for foot drops. However, no relevant and reproducible foot drop animal models with a suitable gait analysis method were developed for the observation of foot drop symptoms. Therefore, the present study aimed to develop a ventral root avulsion (VRA)-induced foot drop rat model and record detailed time-course changes of gait pattern following L5, L6, or L5 + L6 VRA surgery. Our results suggested that L5 + L6 VRA rats exhibited changes in gait patterns, as compared to sham lesion rats, including a significant reduction of walking speed, step length, toe spread, and swing phase time, as well as an increased duration of the stance phase time. The ankle kinematic data exhibited that the ankle joint angle increased during the mid-swing stage, indicating a significant foot drop pattern during locomotion. Time-course observations displayed that these gait impairments occurred as early as the first-day post-lesion and gradually recovered 7-14 days post-injury. We conclude that the proposed foot drop rat model with a video-based gait analysis approach can precisely detect the foot drop pattern induced by VRA in rats, which can provide insight into the compensatory changes and recovery in gait patterns and might be useful for serving as a translational platform bridging human and animal studies for developing novel therapeutic strategies for foot drop.

Review of ankle rehabilitation devices for treatment of equinus contracture

INTRODUCTION

Equinus contracture is a serious disability and attention should be paid to proper and effective treatment. Most attention is given to neurologically impaired patients, but the incidence of equinus contracture is much higher, for example, in post-traumatic patients. In addition to conventional physical therapy, robotic rehabilitation treatment is one of the promising procedures to precede severe contraction cases and the need for surgery.

AREAS COVERED

This study aims to cover the description of different types of stationary and wearable ankle rehabilitation devices suitable for the treatment of equinus contracture and point to deficiency in research, clinical trials, and launch of the market.

EXPERT OPINION

This review provides insight into ankle rehabilitation devices with a focus on equinus contracture. Due to the fact that robotic devices successfully restore the condition of patients, attention should not be paid only to those with neurological impairments. This paper points that future research should be effectively linked to clinical practice with the aim of covering a wider range of disabilities and make an effort to successfully introduce devices from development into the practice.