Journal of Spinal Disorders & Techniques. Volume 24(1) pgs. 1-67,E1-E10 February 2011

Risk Factor Analysis for Motor Deficit and Delayed Recovery Associated With L4/5 Lumbar Disc Herniation.

Suzuki, Akinobu MD, PhD *; Matsumura, Akira MD, PhD +; Konishi, Sadahiko MD, PhD +; Terai, Hidetomi MD, PhD *; Tsujio, Tadao MD *; Dozono, Sho MD *; Nakamura, Hiroaki MD, PhD *. *Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine; †Department of Orthopedic Surgery, Osaka City General Hospital, Osaka, Japan. (C) 2011 Lippincott Williams & Wilkins, Inc.

AB Study Design: Retrospective study of multivariable analysis for the risk factors of motor deficit associated with lumbar disc herniation (LDH).

Objectives: To identify the risk factors for motor deficit and delayed recovery after surgery in patients with LDH.

Summary of Background Data: LDH can cause motor deficit as well as pain and sensory disturbance. Even though motor deficit can lead to disabilities and affect treatment plans, few studies have described motor deficit and its risk factors in LDH patients.

Methods: Seventy-six consecutive patients who underwent microsurgical or microendoscopic discectomy for LDH at the L4/5 level were retrospectively reviewed. Motor deficit was defined as tibialis anterior muscle strength of lower than grade 4 by the manual muscle test, and delayed recovery was defined as cases requiring longer than 3 months to achieve complete recovery. The possible risk factors including sex, age, symptom duration, preoperative radiographic parameters, and type of herniation were evaluated by multivariate logistic regression analysis.

Results: Forty-three patients (56.6%) suffered from motor deficit before surgery. Forty cases (93%) completely recovered within a mean duration of 4 months. Multivariate logistic regression analysis revealed that noncontained-type (P=0.012, odds ratio=13.7) and migrated herniated nucleus pulposus (P=0.033, odds ratio=9.8) were important risk factors for motor deficit. Furthermore, severe motor deficit (preoperative manual muscle test<=3; P=0.019, odds ratio=19.6) and noncontained type (P=0.049, odds ratio=5.17) were identified as important risk factors for delayed recovery.

Conclusions: Noncontained-type or migrated herniated nucleus pulposus seem to be the most important risk factors for motor deficit in LDH, whereas severe motor deficit and noncontained type seem to be associated with delayed recovery. The treatment options for patients with these factors at first visit should be carefully chosen during the follow-up period.