Skip to main content

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

Abstract

Purpose

To analyse the clinic-radiological factors associated with neurological deficit following lumbar disc herniation.

Methods

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.

Results

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).

Conclusion

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.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. Hoy D, Brooks P, Blyth F, Buchbinder R (2010) The epidemiology of low back pain. Best Pract Res Clin Rheumatol 24(6):769–781

    CAS  Article  PubMed  Google Scholar 

  2. Frymoyer JW (1988) Back pain and sciatica. N Engl J Med 318(5):291–300

    CAS  Article  PubMed  Google Scholar 

  3. Weber H (1983) Lumbar disc herniation: a controlled, prospective study with 10 years of observation. Spine 8(2):131–140

    CAS  Article  PubMed  Google Scholar 

  4. Gibson JNA, Waddell G (2007) Surgical interventions for lumbar disc prolapse: updated Cochrane Review. Spine 32(16):1735–1747

    Article  PubMed  Google Scholar 

  5. Blamoutier A (2013) Surgical discectomy for lumbar disc herniation: surgical techniques. Orthop Traumatol Surg Res 99(1):S187–S196

    CAS  Article  PubMed  Google Scholar 

  6. Kostuik JP, Harrington I, Alexander D, Rand W, Evans D (1986) Cauda equina syndrome and lumbar disc herniation. J Bone Jt Surg Am 68(3):386–391

    CAS  Article  Google Scholar 

  7. Kostuik JP (2004) Medicolegal consequences of cauda equina syndrome: an overview. Neurosurg Focus 16(6):39–41

    Article  Google Scholar 

  8. Sutheerayongprasert C, Paiboonsirijit S, Kuansongtham V, Anuraklekha S, Hiranyasthiti N, Neti S (2012) Factors predicting failure of conservative treatment in lumbar-disc herniation. J Med Assoc Thai 95(5):674

    PubMed  Google Scholar 

  9. Cribb GL, Jaffray DC, Cassar-Pullicino VN (2007) Observations on the natural history of massive lumbar disc herniation. Bone Jt J 89(6):782–784

    CAS  Article  Google Scholar 

  10. Bozzao A, Gallucci M, Masciocchi C, Aprile I, Barile A, Passariello R (1992) Lumbar disk herniation: MR imaging assessment of natural history in patients treated without surgery. Radiology 185(1):135–141

    CAS  Article  PubMed  Google Scholar 

  11. Iizuka Y, Iizuka H, Tsutsumi S, Nakagawa Y, Nakajima T, Sorimachi Y et al (2009) Foot drop due to lumbar degenerative conditions: mechanism and prognostic factors in herniated nucleus pulposus and lumbar spinal stenosis. J Neurosurg Spine 10(3):260–264

    Article  PubMed  Google Scholar 

  12. Gitelman A, Hishmeh S, Morelli BN, Joseph SA Jr, Casden A, Kuflik P et al (2008) Cauda equina syndrome: a comprehensive review. Am J Orthop (Belle Mead NJ) 37(11):556–562

    Google Scholar 

  13. Lavy C, James A, MacDonald JW, Fairbank J (2009) Cauda equina syndrome. Br Med J 338:881–884

    Article  Google Scholar 

  14. Weinstein JN, Tosteson TD, Lurie JD, Hanscom B, Skinner JS, Abdu WA et al (2006) Surgical vs nonoperative treatment for lumbar dis herniation. the spine patient outcome research trial (SPORT): a randomised trial. JAMA 296(20):2441–2450

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  15. Haugen AJ, Brox JI, Grovle L, Kellers A, Natvig B, Soldal D et al (2012) Prognostic factors for non-success in patients with sciatica and disc herniation. BMC Musculoskelet Disord 13:183

    Article  PubMed  PubMed Central  Google Scholar 

  16. Nascone JW, Lauerman WC, Wiesel SW (1999) Cauda Equina syndrome: is it a surgical emergency? Univ Pa Orthop J 12:73–76

    Google Scholar 

  17. Simpson JM, Silveri CP, Balderston RA, Simeone FA, An HS (1993) The results of operations on the lumbar spine in patients who have diabetes mellitus. J Bone Jt Surg Am 75(12):1823–1829

    CAS  Article  Google Scholar 

  18. Sakellaridis N (2006) The influence of diabetes mellitus on lumbar intervertebral disk herniation. Surg Neurol 66(2):152–154

    Article  PubMed  Google Scholar 

  19. Epstein NE (2002) Foraminal and far lateral lumbar disc herniations: surgical alternatives and outcome measures. Spinal Cord 40(10):491–500

    CAS  Article  PubMed  Google Scholar 

  20. Ahn Y, Lee SH, Park WM, Lee HY, Shin SW, Kang HY (2004) Percutaneous endoscopic lumbar discectomy for recurrent disc herniation: surgical technique, outcome, and prognostic factors of 43 consecutive cases. Spine 29(16):E326–E332

    Article  PubMed  Google Scholar 

  21. Dora C, Wälchli B, Elfering A, Gal I, Weishaupt D, Boos N (2002) The significance of spinal canal dimensions in discriminating symptomatic from asymptomatic disc herniations. Eur Spine J 11(6):575–581

    Article  PubMed  Google Scholar 

  22. Lurie JD, Faucett SC, Hanscom B, Tosteson TD, Ball PA, Abdu WA et al (2008) Lumbar discectomy outcomes vary by herniation level in the Spine Patient Outcomes Research Trial. J Bone Jt Surg Am 90(9):1811–1819

    CAS  Article  Google Scholar 

  23. Shapiro S (1993) Cauda equina syndrome secondary to lumbar disc herniation. Neurosurgery 32(5):743–747

    CAS  Article  PubMed  Google Scholar 

  24. Suzuki A, Matsumura A, Konishi S, Terai H, Tsujio T, Dozono S, Nakamura H (2011) Risk factor analysis for motor deficit and delayed recovery associated with L4/5 lumbar disc herniation. J Spinal Disord Tech 24(1):1–5

    Article  PubMed  Google Scholar 

  25. Kalemci O, Kizmazoglu C, Ozer E, Arda MN (2013) Lumbar disc herniation associated with contralateral neurological deficit: can venous congestion be the cause? Asian Spine J 7(1):60–62

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Funding was provide by Ganga Orthopaedic Research and Education Foundation, Coimbatore, India.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shanmuganathan Rajasekaran.

Ethics declarations

Conflict of interest

None.

Ethical standards

The study was approved by the institutional review board. The study was conducted in accordance with 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Krishnan, V., Rajasekaran, S., Aiyer, S.N. et al. 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. Eur Spine J 26, 2642–2649 (2017). https://doi.org/10.1007/s00586-017-5019-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-017-5019-5

Keywords

  • Lumbar disc prolapse
  • Neurodeficit
  • Clinico-radiological factors
  • Recovery
  • Prognosis