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Lomber Disk Hernisi Nedeniyle Düşük Ayak Gelişen Hastalarda Semptomların Başlangıcından Ameliyata Kadar Geçen Sürenin Prognoza Etkisi

Yıl 2019, Cilt: 21 Sayı: 3, 177 - 180, 30.12.2019
https://doi.org/10.18678/dtfd.606028

Öz

Amaç: Bu çalışmanın amacı, düşük ayak gelişiminden sinir dekompresyonuna kadar geçen sürenin düşük ayak kliniğinde iyileşme oranı ve derecesi üzerine olan etkilerini değerlendirmektir.

Gereç ve Yöntemler: Nisan 2014 ve Şubat 2019 arasında düşük ayak kliniği (ayak bileği dorsifleksiyonu 0/5 parazik) nedeniyle mikrodiskektomi geçirmiş olan ardışık 30 hasta retrospektif olarak incelendi. Hastalar düşük ayak gelişiminden ameliyata kadar geçen süreye göre <72 saat, 72 saat ile 1 hafta ve >1 hafta olmak üzere göre 3 gruba ayrıldı. Gruplar arasında ameliyat sonrası ayak bileği dorsifleksiyon kas kuvvetlerinin iyileşme oranlarını ve derecesini değerlendirmek için Kruskal-Wallis ve Bonferroni düzeltmeli Mann Whitney U testi kullanıldı.

Bulgular: Bu çalışmada, düşük ayak nedeniyle ameliyat edilen 30 hasta (18 kadın ve 12 erkek) değerlendirilmiştir. Hastaların ameliyat sırasındaki ortalama yaşı 46,5±13,5 (aralık 18-72) idi. Ameliyat sonrası ayak bileği dorsifleksiyonu kas gücü <72 saat grubunda 4,2±1,6 (aralık, 0-5), 72 saat - 1 hafta grubunda 1,7±1,6 (aralık, 0-5) ve >1 hafta grubunda 1,0±1,3 (aralık, 0-3) idi. <72 saat grubunun ameliyat sonrası kas gücü iyileşme seviyesi hem 72 saat - 1 hafta grubundan (p=0,003) hem de >1 hafta grubundan (p=0,002) anlamlı şekilde farklılık göstermekteydi. 72 saat - 1 hafta grubu ve >1 hafta grubu arasında istatistiksel olarak anlamlı bir farklılık görülmedi (p=0,427).

Sonuç: Düşük ayak kliniğinde semptomların başlangıcından cerrahi dekompresyona kadar geçen sürenin, ameliyat sonrası iyileşme oranlarında istatistiksel olarak anlamlı bir prediktör olduğu görüldü.

Kaynakça

  • Baysefer A, Erdogan E, Sali A, Sirin S, Seber N. Foot drop following brain tumors: case reports. Minim Invasive Neurosurg. 1998;41(2):97-8.
  • Stewart JD. Foot drop: where, why and what to do? Pract Neurol. 2008;8(3):158-69.
  • Coleman SH, Beredjeklian PK, Weiland AJ. Intraneural ganglion cyst of the peroneal nerve accompanied by complete foot drop: a case report. Am J Sports Med. 2001;29(2):238-41.
  • Hassan FO, Shannak A. Primary pelvic hydatid cyst: an unusual cause of sciatica and foot drop. Spine (Phila Pa 1976). 2001;26(2):230-2.
  • Yuen EC, So YT. Sciatic neuropathy. Neurol Clin. 1999;17(3):617-31.
  • Bhansali A, Chandran V, Ramesh J, Kashyap A, Dash RJ. Acute myoedema: an unusual presenting manifestation of hypothyroid myopathy. Postgrad Med J. 2000;76(892):99-100.
  • Bhagia SM, Siegelman ES, Gilchrist RV, Slipman CW. Compression fracture: identify the diagnosis. Pain Physician. 2002;5(4):401-4.
  • Aono H, Iwasaki M, Ohwada T, Okuda S, Hosono N, Fuji T, et al. Surgical outcome of foot drop caused by degenerative lumbar diseases. Spine (Phila Pa 1976). 2007;32(8):E262-6.
  • Iizuka Y, Iizuka H, Tsutsumi S, Nakagawa Y, Nakajima T, Sorimachi Y, et al. Foot drop due to lumbar degenerative conditions: mechanism and prognostic factors in herniated nucleus pulposus and lumbar spinal stenosis. J Neurosurg Spine. 2009;10(3):260-4.
  • Jönsson B, Strömqvist B. Motor affliction of the L5 nerve root in lumbar nerve root compression syndromes. Spine (Phila Pa 1976). 1995;20(18):2012-5.
  • Guigui P, Benoist M, Delecourt C, Delhoume J, Deburge A. Motor deficit in lumbar spinal stenosis: a retrospective study of a series of 50 patients. J Spinal Disord. 1998;11(4):283-8.
  • Andersson H, Carlsson CA. Prognosis of operatively treated lumbar disc herniations causing foot extensor paralysis. Acta Chir Scand. 1966;132(5):501-6.
  • Wang Y, Nataraj A. Foot drop resulting from degenerative lumbar spinal diseases: clinical characteristics and prognosis. Clin Neurol Neurosurg. 2014;117:33-9.
  • Naylor A. Late results of laminectomy for lumbar disc prolapse: a review after ten to twenty-five years. J Bone Joint Surg Br. 1974;56(1):17-29.
  • Macki M, Syeda S, Kerezoudis P, Gokaslan ZL, Bydon A, Bydon M. Preoperative motor strength and time to surgery are the most important predictors of improvement in foot drop due to degenerative lumbar disease. J Neurol Sci. 2016;361:133-6.
  • Matsui H, Kitagawa H, Kawaguchi Y, Tsuji H. Physiologic changes of nerve root during posterior lumbar discectomy. Spine (Phila Pa 1976). 1995;20(6):654-9.
  • Girardi FP, Cammisa Jr FP, Huang RC, Parvataneni HK, Tsairis P. Improvement of preoperative foot drop after lumbar surgery. J Spine Disord Tech. 2002;15(6):490-4.
  • Ghahreman A, Ferch RD, Rao P, Chandran N, Shadbolt B. Recovery of ankle dorsiflexion weakness following lumbar decompressive surgery. J Clin Neurosci. 2009;16(8):1024-7.
  • Postacchini F, Giannicola G, Cinotti G. Recovery of motor deficits after microdiscectomy for lumbar disc herniation. J Bone Joint Surgery Br. 2002;84(7):1040-5.
  • Bhargava D, Sinha P, Odak S, Tyagi A, Towns G, Pal D. Surgical outcome for foot drop in lumbar degenerative disease. Global Spine J. 2012;2(3):125-8.
  • Olmarker K. Spinal nerve root compression. Nutrition and function of the porcine cauda equina compressed in vivo. Acta Orthop Scand Suppl. 1991;242:1-27

The Effect of Time Elapsed from the Onset of Symptoms to Surgery on Prognosis in Patients with Foot Drop due to Lumbar Disc Hernia

Yıl 2019, Cilt: 21 Sayı: 3, 177 - 180, 30.12.2019
https://doi.org/10.18678/dtfd.606028

Öz

Aim: The aim of this study was to evaluate the effect of the duration from foot drop development to nerve decompression on the rate and degree of recovery in foot drop clinic.

Material and Methods: We retrospectively reviewed 30 consecutive patients who had undergone microdiscectomy for foot drop clinic (ankle dorsiflexion 0/5 paresis) between April 2014 and February 2019. Patients were divided into three groups according to the time from foot drop development to surgery, as <72 hours, 72 hours to 1 week, and >1 week. Kruskal-Wallis and Bonferroni corrected Mann Whitney U test were used to evaluate the rate and degree of recovery of ankle dorsiflexion muscle strength between groups.

Results: In this study, 30 patients (18 females and 12 males) who underwent surgery for foot drop were evaluated. Mean age at the time of surgery was 46.5±13.5 (range, 18-72) years. Postoperative ankle dorsiflexion strength was 4.2±1.6 (range, 0-5) in <72 hours group, 1.7±1.6 (range, 0-5) in 72 hours - 1 week group and 1.0±1.3 (range, 0-3) in >1 week group. Postoperative muscle strength improvement level of <72 hours group was significantly different both from 72 hours - 1 week group (p=0.003) and from >1 week group (p=0.002). There was no statistically significant difference between 72 hours - 1 week group and >1 week group (p=0.427).

Conclusion: In foot drop clinic, the duration from onset of symptoms to surgical decompression was a statistically significant predictor of postoperative recovery rates.

Kaynakça

  • Baysefer A, Erdogan E, Sali A, Sirin S, Seber N. Foot drop following brain tumors: case reports. Minim Invasive Neurosurg. 1998;41(2):97-8.
  • Stewart JD. Foot drop: where, why and what to do? Pract Neurol. 2008;8(3):158-69.
  • Coleman SH, Beredjeklian PK, Weiland AJ. Intraneural ganglion cyst of the peroneal nerve accompanied by complete foot drop: a case report. Am J Sports Med. 2001;29(2):238-41.
  • Hassan FO, Shannak A. Primary pelvic hydatid cyst: an unusual cause of sciatica and foot drop. Spine (Phila Pa 1976). 2001;26(2):230-2.
  • Yuen EC, So YT. Sciatic neuropathy. Neurol Clin. 1999;17(3):617-31.
  • Bhansali A, Chandran V, Ramesh J, Kashyap A, Dash RJ. Acute myoedema: an unusual presenting manifestation of hypothyroid myopathy. Postgrad Med J. 2000;76(892):99-100.
  • Bhagia SM, Siegelman ES, Gilchrist RV, Slipman CW. Compression fracture: identify the diagnosis. Pain Physician. 2002;5(4):401-4.
  • Aono H, Iwasaki M, Ohwada T, Okuda S, Hosono N, Fuji T, et al. Surgical outcome of foot drop caused by degenerative lumbar diseases. Spine (Phila Pa 1976). 2007;32(8):E262-6.
  • Iizuka Y, Iizuka H, Tsutsumi S, Nakagawa Y, Nakajima T, Sorimachi Y, et al. Foot drop due to lumbar degenerative conditions: mechanism and prognostic factors in herniated nucleus pulposus and lumbar spinal stenosis. J Neurosurg Spine. 2009;10(3):260-4.
  • Jönsson B, Strömqvist B. Motor affliction of the L5 nerve root in lumbar nerve root compression syndromes. Spine (Phila Pa 1976). 1995;20(18):2012-5.
  • Guigui P, Benoist M, Delecourt C, Delhoume J, Deburge A. Motor deficit in lumbar spinal stenosis: a retrospective study of a series of 50 patients. J Spinal Disord. 1998;11(4):283-8.
  • Andersson H, Carlsson CA. Prognosis of operatively treated lumbar disc herniations causing foot extensor paralysis. Acta Chir Scand. 1966;132(5):501-6.
  • Wang Y, Nataraj A. Foot drop resulting from degenerative lumbar spinal diseases: clinical characteristics and prognosis. Clin Neurol Neurosurg. 2014;117:33-9.
  • Naylor A. Late results of laminectomy for lumbar disc prolapse: a review after ten to twenty-five years. J Bone Joint Surg Br. 1974;56(1):17-29.
  • Macki M, Syeda S, Kerezoudis P, Gokaslan ZL, Bydon A, Bydon M. Preoperative motor strength and time to surgery are the most important predictors of improvement in foot drop due to degenerative lumbar disease. J Neurol Sci. 2016;361:133-6.
  • Matsui H, Kitagawa H, Kawaguchi Y, Tsuji H. Physiologic changes of nerve root during posterior lumbar discectomy. Spine (Phila Pa 1976). 1995;20(6):654-9.
  • Girardi FP, Cammisa Jr FP, Huang RC, Parvataneni HK, Tsairis P. Improvement of preoperative foot drop after lumbar surgery. J Spine Disord Tech. 2002;15(6):490-4.
  • Ghahreman A, Ferch RD, Rao P, Chandran N, Shadbolt B. Recovery of ankle dorsiflexion weakness following lumbar decompressive surgery. J Clin Neurosci. 2009;16(8):1024-7.
  • Postacchini F, Giannicola G, Cinotti G. Recovery of motor deficits after microdiscectomy for lumbar disc herniation. J Bone Joint Surgery Br. 2002;84(7):1040-5.
  • Bhargava D, Sinha P, Odak S, Tyagi A, Towns G, Pal D. Surgical outcome for foot drop in lumbar degenerative disease. Global Spine J. 2012;2(3):125-8.
  • Olmarker K. Spinal nerve root compression. Nutrition and function of the porcine cauda equina compressed in vivo. Acta Orthop Scand Suppl. 1991;242:1-27
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Araştırma Makalesi
Yazarlar

Mehmet Onur Yüksel 0000-0003-0922-4249

Serdar Çevik 0000-0002-2733-4233

Yayımlanma Tarihi 30 Aralık 2019
Gönderilme Tarihi 18 Ağustos 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 21 Sayı: 3

Kaynak Göster

APA Yüksel, M. O., & Çevik, S. (2019). The Effect of Time Elapsed from the Onset of Symptoms to Surgery on Prognosis in Patients with Foot Drop due to Lumbar Disc Hernia. Duzce Medical Journal, 21(3), 177-180. https://doi.org/10.18678/dtfd.606028
AMA Yüksel MO, Çevik S. The Effect of Time Elapsed from the Onset of Symptoms to Surgery on Prognosis in Patients with Foot Drop due to Lumbar Disc Hernia. Duzce Med J. Aralık 2019;21(3):177-180. doi:10.18678/dtfd.606028
Chicago Yüksel, Mehmet Onur, ve Serdar Çevik. “The Effect of Time Elapsed from the Onset of Symptoms to Surgery on Prognosis in Patients With Foot Drop Due to Lumbar Disc Hernia”. Duzce Medical Journal 21, sy. 3 (Aralık 2019): 177-80. https://doi.org/10.18678/dtfd.606028.
EndNote Yüksel MO, Çevik S (01 Aralık 2019) The Effect of Time Elapsed from the Onset of Symptoms to Surgery on Prognosis in Patients with Foot Drop due to Lumbar Disc Hernia. Duzce Medical Journal 21 3 177–180.
IEEE M. O. Yüksel ve S. Çevik, “The Effect of Time Elapsed from the Onset of Symptoms to Surgery on Prognosis in Patients with Foot Drop due to Lumbar Disc Hernia”, Duzce Med J, c. 21, sy. 3, ss. 177–180, 2019, doi: 10.18678/dtfd.606028.
ISNAD Yüksel, Mehmet Onur - Çevik, Serdar. “The Effect of Time Elapsed from the Onset of Symptoms to Surgery on Prognosis in Patients With Foot Drop Due to Lumbar Disc Hernia”. Duzce Medical Journal 21/3 (Aralık 2019), 177-180. https://doi.org/10.18678/dtfd.606028.
JAMA Yüksel MO, Çevik S. The Effect of Time Elapsed from the Onset of Symptoms to Surgery on Prognosis in Patients with Foot Drop due to Lumbar Disc Hernia. Duzce Med J. 2019;21:177–180.
MLA Yüksel, Mehmet Onur ve Serdar Çevik. “The Effect of Time Elapsed from the Onset of Symptoms to Surgery on Prognosis in Patients With Foot Drop Due to Lumbar Disc Hernia”. Duzce Medical Journal, c. 21, sy. 3, 2019, ss. 177-80, doi:10.18678/dtfd.606028.
Vancouver Yüksel MO, Çevik S. The Effect of Time Elapsed from the Onset of Symptoms to Surgery on Prognosis in Patients with Foot Drop due to Lumbar Disc Hernia. Duzce Med J. 2019;21(3):177-80.
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