Waseem S, Kyriakides J, Amiri A R, Shetty R, Shetty N, Chammaa R
Department of Trauma and Orthopaedics, The Whittington Hospital, Magdala Avenue, London, UK.
Eur Spine J. 2023 Apr;32(4):1099-1105. doi: 10.1007/s00586-023-07534-6. Epub 2023 Feb 26.
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.
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.
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).
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.
足下垂罕见地作为退行性脊柱疾病的无痛性表现症状出现。本系统评价旨在总结关于无痛性足下垂患者的治疗及预后的文献。
我们根据PRISMA指南对PubMed、EMBASE和Medline进行了系统评价。纳入所有1980年后发表的英文文献，这些文献涉及成年无痛性足下垂患者。排除标准包括基于观点的报告、综述文章以及足下垂并非由胸腰椎退行性病变引起的文章。
纳入的62例患者中，30例（48.4%）为男性，平均年龄48.7岁（范围27 - 84岁）。症状的平均持续时间为69.0天（1 - 700天）。98.8%的患者接受了手术治疗。46例（74.2%）患者症状改善，41例（66.1%）干预后医学研究委员会（MRC）肌力分级为3级或以上。术前MRC为0级的患者术后MRC的中位数增加幅度高于MRC＞0级的患者。在两项比较疼痛性和无痛性症状的研究中，无痛性足下垂患者恢复到MRC等于或超过3级的可能性低于疼痛性症状患者，比值比为0.31（95%可信区间0.04 - 2.65）。
本系统评价和荟萃分析表明手术在促进无痛性足下垂患者神经功能恢复方面具有作用。需要开展大型随机对照研究来明确手术干预在这些患者中的作用，并比较无痛性和疼痛性足下垂患者的预后。
