Iizuka Yoichi, Iizuka Haku, Tsutsumi Satoshi, Nakagawa Yumi, Nakajima Takashi, Sorimachi Yasunori, Ara Tsuyoshi, Nishinome Masahiro, Seki Takayuki, Shida Kosuke, Takagishi Kenji
Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
J Neurosurg Spine. 2009 Mar;10(3):260-4. doi: 10.3171/2008.12.SPINE08500.
The aim of this study was to analyze the mechanism and prognostic factors of foot drop caused by lumbar degenerative conditions.
The authors retrospectively reviewed the charts of 28 patients with foot drop due to a herniated nucleus pulposus (HNP) or lumbar spinal stenosis (LSS), scoring between 0 and 3 on manual muscle testing for the tibialis anterior muscles. They analyzed the mechanism of foot drop and whether the duration before the operation, preoperative tibialis anterior and extensor hallucis longus strength, age, gender, and diabetes mellitus were all found to be prognostic factors for postoperative tibialis anterior recovery. They also investigated whether the diagnosis had any influence on the prognosis.
The compression of double roots and a sequestrated fragment were observed, respectively, in 9 and 13 of 16 patients with HNP. Multiple levels including the L4-5 segment were decompressed in 8 of 12 patients with LSS. Analysis did not demonstrate any prognostic factor in surgically treated HNP, but significant associations with prognosis were observed with respect to preoperative tibialis anterior (p = 0.033) and extensor hallucis longus (p = 0.020) strength in patients with LSS. In addition, the postoperative muscle recovery in patients with HNP was significantly superior to that in patients with LSS (p = 0.011).
Double root compression was the most common condition associated with foot drop due to HNP. The diagnosis and preoperative tibialis anterior and extensor hallucis longus strength in LSS were factors that influenced recovery following an operation.
本研究旨在分析腰椎退行性疾病所致足下垂的机制及预后因素。
作者回顾性分析了28例因椎间盘突出症（HNP）或腰椎管狭窄症（LSS）导致足下垂患者的病历，对胫前肌进行徒手肌力测试，评分在0至3分之间。他们分析了足下垂的机制，以及手术前的病程、术前胫前肌和拇长伸肌力量、年龄、性别和糖尿病是否均为术后胫前肌恢复的预后因素。他们还研究了诊断对预后是否有任何影响。
在16例HNP患者中，分别有9例和13例观察到双根受压和游离碎骨片。12例LSS患者中有8例在包括L4 - 5节段在内的多个节段进行了减压。分析未显示手术治疗的HNP有任何预后因素，但在LSS患者中，观察到术前胫前肌力量（p = 0.033）和拇长伸肌力量（p = 0.020）与预后有显著相关性。此外，HNP患者术后肌肉恢复明显优于LSS患者（p = 0.011）。
双根受压是HNP所致足下垂最常见的情况。LSS的诊断以及术前胫前肌和拇长伸肌力量是影响手术后恢复的因素。
