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- Title
Clinical and radiological factors related to the presence of motor deficit in lumbar disc prolapse: a prospective analysis of 70 consecutive cases with neurological deficit.
- Authors
Krishnan, Vibhu; Rajasekaran, Shanmuganathan; Aiyer, Siddharth; Kanna, Rishi; Shetty, Ajoy; Aiyer, Siddharth N; Shetty, Ajoy Prasad
- Abstract
<bold>Purpose: </bold>To analyse the clinic-radiological factors associated with neurological deficit following lumbar disc herniation.<bold>Methods: </bold>A prospective, cross-sectional study was performed in 140 cases of micro-discectomy following lumbar disc herniation. Group 1 included 70 consecutive patients with motor deficit and group 2 (controls) included 70 patients with intact neurology. Motor deficit was defined as the occurrence of motor power ≤3/5 in L2-S1 myotomes. Multiple clinical and radiological parameters were studied between the two groups.<bold>Results: </bold>Patients with diabetes (p 0.004), acute onset of symptoms (p 0.036), L3-4 discs (p 0.001), sequestrated discs (p 0.004), superiorly migrated discs (p 0.012) and central discs (p 0.004), greater antero-posterior disc dimension (p 0.023), primary canal stenosis (p 0.0001); and greater canal compromise (p 0.002) had a significant correlation with the development of neurological deficit. The presence of four or more of these risk factors showed a higher chance of the presence of motor deficit (sensitivity of 74%, specificity of 77%). Age, sex, previous precipitating events, severity of pain, smoking, and number of herniations levels did not affect the occurrence of deficit (p > 0.05 for all). Patients with or without bladder symptoms were similar with respect to all clinico-radiological parameters. However, the time delay since the occurrence of deficit was significantly shorter in patients with bladder involvement (p 0.001).<bold>Conclusion: </bold>Patients with diabetes, acute presentation, central, sequestrated and superiorly migrated discs, high lumbar disc prolapse, and greater spinal canal compromise are predisposed to the presence of motor deficit.
- Subjects
INTERVERTEBRAL disk hernias; MOVEMENT disorders; DISCECTOMY; SYMPTOMS; MEDICAL radiology; DISEASE risk factors; LUMBAR vertebrae surgery; DIABETES; INTERVERTEBRAL disk displacement; LONGITUDINAL method; LUMBAR vertebrae; SPINAL stenosis; CROSS-sectional method; CASE-control method; MUSCLE weakness
- Publication
European Spine Journal, 2017, Vol 26, Issue 10, p2642
- ISSN
0940-6719
- Publication type
journal article
- DOI
10.1007/s00586-017-5019-5