Surgical outcomes of unilateral painful foot drop secondary to lumbar disc herniation: a multicenter retrospective study
Published research co-authored by Mr Gordan Grahovac
This multicentre study reviewed outcomes after surgery for painful foot drop caused by lumbar disc herniation. It reported that younger, less frail patients and earlier surgery were associated with better recovery, while noting that no precise timing cut-off was identified.
Research snapshot
Article title: Surgical outcomes of unilateral painful foot drop secondary to lumbar disc herniation: a multicenter retrospective study
Authors: Asfand Baig Mirza, Amisha Vastani, Feras Fayez, Rishabh Suvarna, Mustafa El Sheikh, Chaitanya Sharma, Maria Alexandra Velicu, David Rowland, Jandira Trindade, Sebastian M Toescu, Suzanne M Murphy, Malaika Jindal, Gerda Reischer, Paula Corr, Deirdre Nolan, Alice Sims-Williams, Charlotte Read, Eranga Goonewardena, Nabilah Johani, Christoforos Syrris, Anand S Pandit, Sami Rashed, Abbas Khizar Khoja, Samir Matloob, Jonathan Bull, Alexander Montgomery, Catherine Moran, Parag Sayal, Samih Hassan, Mohamed Okasha, Ali Nader-Sepahi, Irfan Malik, Babak Arvin, Ahmed Ramadan Sadek, Gordan Grahovac
Publication type: Journal article
Publication date: 4 April 2025
Publication details: Journal of Neurosurgery: Spine. 2025;42(6):727-736.
PMID: 40184689
PMCID:
DOI: 10.3171/2024.12.SPINE24713
Study type: Multicentre retrospective study
Mr Grahovac’s involvement: Listed author on the publication
Original publication: View the original publication on PubMed
What this paper looked at
This paper examined adults who had lumbar discectomy for unilateral painful foot drop caused by lumbar disc herniation, excluding cauda equina syndrome. The study covered seven centres and reviewed cases from September 2011 to September 2022.
Key points from the publication
The study included 75 patients. The authors reported improvement in Medical Research Council muscle grades in 41 patients, no change in 23 and worsening in 11. Earlier surgery, younger age and lower frailty were associated with better outcomes, but the authors did not identify a precise surgical timing cut-off.
Clinical relevance
The paper is clinically relevant for counselling patients with painful foot drop from lumbar disc herniation and for considering timing, frailty and baseline weakness when planning surgery.
What this means in context
The study does not mean all patients with foot drop have the same outlook or should follow the same pathway. Assessment should consider symptom duration, weakness severity, pain, imaging, frailty, general health and surgical risk.
View published abstract
The following abstract is reproduced from the original publication and is provided for reference. It may include technical terminology intended for clinical or academic audiences.
Objective: Foot drop is characterized by weakness in ankle dorsiflexion, primarily due to failure of activation of dorsiflexor muscles secondary to neural compromise. The aim of this study was to evaluate surgical outcomes for unilateral painful foot drop secondary to lumbar disc herniation, specifically excluding cases with cauda equina syndrome.
Methods: This retrospective study spanned 7 centers, focusing on adult patients who underwent lumbar discectomies from September 2011 to September 2022 due to painful unilateral foot drop (Medical Research Council [MRC] grade ≤ 3). Clinical records were analyzed to identify patients matching the inclusion criteria, with data collection adhering to PROCESS guidelines. Outcomes were assessed based on the MRC scale for muscle strength, and statistical analysis was conducted to determine outcome predictors.
Results: This study included 75 patients (mean age 49.03 years, 1:1.007 male/female ratio). Early surgery in younger and less frail patients was associated with better outcomes, with no precise surgical timing cutoff identified. Improvement in MRC grades was seen in 41 patients (55%), with no change in 23 patients (31%) and worsening grades in 11 patients (15%). For every day delaying surgery, the likelihood of improvement decreased by 0.2%. The severity of foot drop was associated with a reduced likelihood of complete resolution, although some recovery was demonstrated. Functional recovery was consistently higher in patients with higher presenting MRC grades. Radicular pain consistently improved following surgical intervention irrespective of all other analyzed metrics.
Conclusions: Prompt surgical intervention for patients with foot drop improved outcomes, especially in those who were younger and less frail. While the study did not identify a specific cutoff for the timing of surgery, the findings emphasize the importance of early surgical consideration as delays were associated with reduced likelihood of recovery. Future research should focus on prospective studies to validate these findings and refine guidelines for surgical intervention in this patient population.
Keywords: degenerative; foot drop; lumbar disc herniation.
View the original publication on PubMed
About Mr Gordan Grahovac
Mr Gordan Grahovac is a Consultant Neurosurgeon and Complex Spinal Surgeon with expertise in managing complex spinal and neurosurgical conditions.
His work includes the assessment and treatment of patients with degenerative spinal conditions, spinal cord compression, spinal tumours, complex spinal pathology and conditions requiring specialist neurosurgical input.
His approach focuses on careful diagnosis, appropriate treatment planning and helping patients understand their options clearly.
Important note
This page is for educational purposes only and should not be taken as individual medical advice.
If you or someone you know has symptoms such as worsening headache, confusion, drowsiness, weakness, changes in speech, seizures, balance problems or symptoms following a head injury, seek urgent medical advice.
