Lumber Disc Herniation - An Unusual Aetiology of Acute Painless Synchronous Foot Drop

Mohamed Awad Mohamed Hassan; Majed Saleh Alanazi; Amjad Abdulkader Ahmad Darwish; Abdulhafeez Osman Eltoum Mohamed; Salah Hani Sharif; Saggaf Alawi Assaggaf

doi:doi:10.11648/j.ijn.20220602.15

Lumber Disc Herniation - An Unusual Aetiology of Acute Painless Synchronous Foot Drop

Mohamed Awad Mohamed Hassan, Majed Saleh Alanazi, Amjad Abdulkader Ahmad Darwish, Abdulhafeez Osman Eltoum Mohamed, Salah Hani Sharif, Saggaf Alawi Assaggaf

Published in International Journal of Neurosurgery (Volume 6, Issue 2)

Received: 11 September 2022 Accepted: 22 September 2022 Published: 29 September 2022

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Abstract

Background and importance: Acute bilateral painless foot drop is a common symptom of various diagnoses and consider a red flag sign for a serious pathology in the central or peripheral nervous system including cerebral, spinal, and peripheral causes. Therefore, medical history and careful clinical examination are often used in the neurotopographic classification. Acute painless bilateral Foot drop (FD) is an uncommon initial manifestation of nerve root compression secondary to acute lumbar disc herniation not associated with low back pain and radiculopathy. In most patients with lumber disc herniation, FD is unilateral and is associated with low back pain and leg pain. Few cases have been described as bilateral FD, occurring simultaneously. Chronic bilateral foot drop as a sequela of systemic illnesses has been well-studied; however, acute painless bilateral foot drops not associated with radiculopathy or back pain in a healthy person should be immediately investigated, cauda equina syndrome is not necessarily to be associated with acute bilateral foot drop as shown in our case here. This study highlights the unusual presentation of lumber disc prolapse and illustrates the importance of palsy duration, early diagnosis, and time to surgery as predicting factors for improvement. The author presents bilateral acute foot drop case associated with lumbar discopathy without back pain, radiculopathy, or cauda equina symptoms as an unusual initial manifestation of lumbar discopathy. The current study aimed to provide insight on the lumbar acute painless etiology of bilateral FD in a patient without radiculopathy and back pain to prevent functional loss. Moreover, it emphasized the rare initial manifestations of lumbar disc prolapse and the importance of predictive factors of improvement such as palsy duration, early diagnosis, and time to surgery. To illustrate work-up for bilateral foot drop in acute setting presentation. A systematic review was conducted using PubMed and google scholar. Demographic and radiological data were obtained from a painless acute bilateral foot drop presented to our neurosurgery unit. We reviewed the patient demographics, clinical presentation, radiological parameters, surgical parameters, and time from presentation to surgery. In addition, preoperative, early postoperative, and most recent follow-up neurological examinations were compared. Our patient improved gradually after the surgery, on the first postoperative day, we obtained an MMT (Manual Muscle Test) Scoring < 3 on admission, and third day postoperative MMT Scoring of 3. After six weeks, the last follow-up had an MMT Score of 5 for both ankles.

Published in	International Journal of Neurosurgery (Volume 6, Issue 2)
DOI	10.11648/j.ijn.20220602.15
Page(s)	52-55
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Acute, Manual Muscle Test, Disc Prolapse, Bilateral Foot Drop, Neurotopographic Classification

References

[1]	Liu, K., et al., 2013. Foot drop caused by lumbar degenerative disease: Clinical features, prognostic factors of surgical outcome and clinical stage. PLoS One, 8, e80375.
[2]	Aono, H., et al., 2007. Surgical outcome of drop foot caused by degenerative lumbar diseases. Spine, 13 (8), E262–E266.
[3]	Voermans, N. C., Koetsveld, A. C., and Zwarts, M. J., (2006). Segmental overlap: Foot drop in S1 radiculopathy. Acta Neurochirurgica, 148 (7), 809–813.
[4]	Baima, J. and Krivickas, L., 2008. Evaluation and treatment of peroneal neuropathy. Current Reviews in Musculoskeletal Medicine, 1 (2), 147–153.
[5]	McCulloch, J., and Waddell, G., 1980. Variation of the lumbosacral myotome with bony segmental anomalies. Journal of Bone and Joint Surgery. (British Volume), 62 (7), 475–480.
[6]	French, Y. D., 1946. Clinical manifestation of lumber spinal arachnoiditis: a report of 13 cases. Surgery, 20, 718–729.
[7]	Gately, R. P., Rashid, M. B., 2018. Hypothyroid myositis causing bilateral foot drop. Radiology, 289 (1), 28–28.
[8]	Shahani, B. and Spalding, J. M., 1969. Diabetes mellitus presenting with bilateral foot-drop. The Lancet, 294 (7627), 930–931.
[9]	Gilad, R. and Sadeh, M., 2000. Bilateral foot drop as a manifestation of myasthenia gravis. Journal of Clinical Neuromuscular Disease, 2 (1), 23.
[10]	Partanen, J., 1996. Anterior tibial dystrophy (late onset foot drop muscular dystrophy with rimmed vacuoles). Neurologia i Neurochirurgia Polska, 30, 77–80.
[11]	Sweid, A., et al., 2019. Case report of a partially thrombosed ACoA aneurysm presenting with bilateral foot drop. Clinical Neurology and Neurosurgery, 185, 105490.
[12]	Rispoli, R., et al., 2009. Bilateral acute foot drop in a case of axonal injury. A case report. The Neuroradiology Journal, 22 (2), 191–193.
[13]	Wang, Y. and Nataraj, A., 2014. Foot drop resulting from degenerative lumbar spinal diseases: clinical characteristics and prognosis. Clinical Neurology and Neurosurgery, 117, 33–39.
[14]	Adsul, N., et al., 2018. Acute bilateral isolated foot drop: changing the paradigm in management of degenerative spine surgery with percutaneous endoscopy. World Neurosurgery, 110, 319–322.
[15]	Gürer, B., et al., 2015. Acute bilateral isolated foot drop: report of two cases. Asian Journal of Neurosurgery, 10 (2), 123–125.
[16]	Mahapatra, A. K., et al., 2003. Sudden bilateral foot drop: an unusual presentation of lumbar disc prolapse. Neurology India, 51 (1), 71–72.
[17]	Marchesini, N., et al., 2020. Acute bilateral foot drop due to lumbar disc herniation treated by bilateral interlaminar approach: case report and literature review. British Journal of Neurosurgery, 1–3.
[18]	Giradi, F. P., et al., 2002. Improvement of preoperative foot drop after lumber surgery. Clinical Spine Surgery, 15 (6), 490–494.
[19]	Aono, H., et al., 2014. Surgical outcomes for painless drop foot due to degenerative lumber disorders. Clinical Spine Surgery, 27 (7), E258–E261.

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Mohamed Awad Mohamed Hassan, Majed Saleh Alanazi, Amjad Abdulkader Ahmad Darwish, Abdulhafeez Osman Eltoum Mohamed, Salah Hani Sharif, et al. (2022). Lumber Disc Herniation - An Unusual Aetiology of Acute Painless Synchronous Foot Drop. International Journal of Neurosurgery, 6(2), 52-55. https://doi.org/10.11648/j.ijn.20220602.15

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Mohamed Awad Mohamed Hassan; Majed Saleh Alanazi; Amjad Abdulkader Ahmad Darwish; Abdulhafeez Osman Eltoum Mohamed; Salah Hani Sharif, et al. Lumber Disc Herniation - An Unusual Aetiology of Acute Painless Synchronous Foot Drop. Int. J. Neurosurg. 2022, 6(2), 52-55. doi: 10.11648/j.ijn.20220602.15

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AMA Style

Mohamed Awad Mohamed Hassan, Majed Saleh Alanazi, Amjad Abdulkader Ahmad Darwish, Abdulhafeez Osman Eltoum Mohamed, Salah Hani Sharif, et al. Lumber Disc Herniation - An Unusual Aetiology of Acute Painless Synchronous Foot Drop. Int J Neurosurg. 2022;6(2):52-55. doi: 10.11648/j.ijn.20220602.15

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@article{10.11648/j.ijn.20220602.15,
  author = {Mohamed Awad Mohamed Hassan and Majed Saleh Alanazi and Amjad Abdulkader Ahmad Darwish and Abdulhafeez Osman Eltoum Mohamed and Salah Hani Sharif and Saggaf Alawi Assaggaf},
  title = {Lumber Disc Herniation - An Unusual Aetiology of Acute Painless Synchronous Foot Drop},
  journal = {International Journal of Neurosurgery},
  volume = {6},
  number = {2},
  pages = {52-55},
  doi = {10.11648/j.ijn.20220602.15},
  url = {https://doi.org/10.11648/j.ijn.20220602.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20220602.15},
  abstract = {Background and importance: Acute bilateral painless foot drop is a common symptom of various diagnoses and consider a red flag sign for a serious pathology in the central or peripheral nervous system including cerebral, spinal, and peripheral causes. Therefore, medical history and careful clinical examination are often used in the neurotopographic classification. Acute painless bilateral Foot drop (FD) is an uncommon initial manifestation of nerve root compression secondary to acute lumbar disc herniation not associated with low back pain and radiculopathy. In most patients with lumber disc herniation, FD is unilateral and is associated with low back pain and leg pain. Few cases have been described as bilateral FD, occurring simultaneously. Chronic bilateral foot drop as a sequela of systemic illnesses has been well-studied; however, acute painless bilateral foot drops not associated with radiculopathy or back pain in a healthy person should be immediately investigated, cauda equina syndrome is not necessarily to be associated with acute bilateral foot drop as shown in our case here. This study highlights the unusual presentation of lumber disc prolapse and illustrates the importance of palsy duration, early diagnosis, and time to surgery as predicting factors for improvement. The author presents bilateral acute foot drop case associated with lumbar discopathy without back pain, radiculopathy, or cauda equina symptoms as an unusual initial manifestation of lumbar discopathy. The current study aimed to provide insight on the lumbar acute painless etiology of bilateral FD in a patient without radiculopathy and back pain to prevent functional loss. Moreover, it emphasized the rare initial manifestations of lumbar disc prolapse and the importance of predictive factors of improvement such as palsy duration, early diagnosis, and time to surgery. To illustrate work-up for bilateral foot drop in acute setting presentation. A systematic review was conducted using PubMed and google scholar. Demographic and radiological data were obtained from a painless acute bilateral foot drop presented to our neurosurgery unit. We reviewed the patient demographics, clinical presentation, radiological parameters, surgical parameters, and time from presentation to surgery. In addition, preoperative, early postoperative, and most recent follow-up neurological examinations were compared. Our patient improved gradually after the surgery, on the first postoperative day, we obtained an MMT (Manual Muscle Test) Scoring < 3 on admission, and third day postoperative MMT Scoring of 3. After six weeks, the last follow-up had an MMT Score of 5 for both ankles.},
 year = {2022}
}

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TY - JOUR
T1 - Lumber Disc Herniation - An Unusual Aetiology of Acute Painless Synchronous Foot Drop
AU - Mohamed Awad Mohamed Hassan
AU - Majed Saleh Alanazi
AU - Amjad Abdulkader Ahmad Darwish
AU - Abdulhafeez Osman Eltoum Mohamed
AU - Salah Hani Sharif
AU - Saggaf Alawi Assaggaf
Y1 - 2022/09/29
PY - 2022
N1 - https://doi.org/10.11648/j.ijn.20220602.15
DO - 10.11648/j.ijn.20220602.15
T2 - International Journal of Neurosurgery
JF - International Journal of Neurosurgery
JO - International Journal of Neurosurgery
SP - 52
EP - 55
PB - Science Publishing Group
SN - 2640-1959
UR - https://doi.org/10.11648/j.ijn.20220602.15
AB - Background and importance: Acute bilateral painless foot drop is a common symptom of various diagnoses and consider a red flag sign for a serious pathology in the central or peripheral nervous system including cerebral, spinal, and peripheral causes. Therefore, medical history and careful clinical examination are often used in the neurotopographic classification. Acute painless bilateral Foot drop (FD) is an uncommon initial manifestation of nerve root compression secondary to acute lumbar disc herniation not associated with low back pain and radiculopathy. In most patients with lumber disc herniation, FD is unilateral and is associated with low back pain and leg pain. Few cases have been described as bilateral FD, occurring simultaneously. Chronic bilateral foot drop as a sequela of systemic illnesses has been well-studied; however, acute painless bilateral foot drops not associated with radiculopathy or back pain in a healthy person should be immediately investigated, cauda equina syndrome is not necessarily to be associated with acute bilateral foot drop as shown in our case here. This study highlights the unusual presentation of lumber disc prolapse and illustrates the importance of palsy duration, early diagnosis, and time to surgery as predicting factors for improvement. The author presents bilateral acute foot drop case associated with lumbar discopathy without back pain, radiculopathy, or cauda equina symptoms as an unusual initial manifestation of lumbar discopathy. The current study aimed to provide insight on the lumbar acute painless etiology of bilateral FD in a patient without radiculopathy and back pain to prevent functional loss. Moreover, it emphasized the rare initial manifestations of lumbar disc prolapse and the importance of predictive factors of improvement such as palsy duration, early diagnosis, and time to surgery. To illustrate work-up for bilateral foot drop in acute setting presentation. A systematic review was conducted using PubMed and google scholar. Demographic and radiological data were obtained from a painless acute bilateral foot drop presented to our neurosurgery unit. We reviewed the patient demographics, clinical presentation, radiological parameters, surgical parameters, and time from presentation to surgery. In addition, preoperative, early postoperative, and most recent follow-up neurological examinations were compared. Our patient improved gradually after the surgery, on the first postoperative day, we obtained an MMT (Manual Muscle Test) Scoring < 3 on admission, and third day postoperative MMT Scoring of 3. After six weeks, the last follow-up had an MMT Score of 5 for both ankles.
VL - 6
IS - 2
ER -

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Author Information

Mohamed Awad Mohamed Hassan

Department of Neurosurgery, King Khalid Hospital, Hail, Kingdom of Saudi Arabia
Majed Saleh Alanazi

Rheumatology Unit, King Khalid Hospital, Hail, Kingdom of Saudi Arabia
Amjad Abdulkader Ahmad Darwish

Neurosurgery Unit, King Fahad Military Medical Complex, Dhahran, Kingdom of Saudi Arabia
Abdulhafeez Osman Eltoum Mohamed

Internal Medicine Department, King Khalid Hospital, Hail, Kingdom of Saudi Arabia
Salah Hani Sharif

Radiology Department, King Khalid Hospital, Hail, Kingdom of Saudi Arabia
Saggaf Alawi Assaggaf

Neurosurgery Unit, King Khalid Hospital, Hail, Kingdom of Saudi Arabia

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APA Style

Mohamed Awad Mohamed Hassan, Majed Saleh Alanazi, Amjad Abdulkader Ahmad Darwish, Abdulhafeez Osman Eltoum Mohamed, Salah Hani Sharif, et al. (2022). Lumber Disc Herniation - An Unusual Aetiology of Acute Painless Synchronous Foot Drop. International Journal of Neurosurgery, 6(2), 52-55. https://doi.org/10.11648/j.ijn.20220602.15

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ACS Style

Mohamed Awad Mohamed Hassan; Majed Saleh Alanazi; Amjad Abdulkader Ahmad Darwish; Abdulhafeez Osman Eltoum Mohamed; Salah Hani Sharif, et al. Lumber Disc Herniation - An Unusual Aetiology of Acute Painless Synchronous Foot Drop. Int. J. Neurosurg. 2022, 6(2), 52-55. doi: 10.11648/j.ijn.20220602.15

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AMA Style

Mohamed Awad Mohamed Hassan, Majed Saleh Alanazi, Amjad Abdulkader Ahmad Darwish, Abdulhafeez Osman Eltoum Mohamed, Salah Hani Sharif, et al. Lumber Disc Herniation - An Unusual Aetiology of Acute Painless Synchronous Foot Drop. Int J Neurosurg. 2022;6(2):52-55. doi: 10.11648/j.ijn.20220602.15

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@article{10.11648/j.ijn.20220602.15,
  author = {Mohamed Awad Mohamed Hassan and Majed Saleh Alanazi and Amjad Abdulkader Ahmad Darwish and Abdulhafeez Osman Eltoum Mohamed and Salah Hani Sharif and Saggaf Alawi Assaggaf},
  title = {Lumber Disc Herniation - An Unusual Aetiology of Acute Painless Synchronous Foot Drop},
  journal = {International Journal of Neurosurgery},
  volume = {6},
  number = {2},
  pages = {52-55},
  doi = {10.11648/j.ijn.20220602.15},
  url = {https://doi.org/10.11648/j.ijn.20220602.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20220602.15},
  abstract = {Background and importance: Acute bilateral painless foot drop is a common symptom of various diagnoses and consider a red flag sign for a serious pathology in the central or peripheral nervous system including cerebral, spinal, and peripheral causes. Therefore, medical history and careful clinical examination are often used in the neurotopographic classification. Acute painless bilateral Foot drop (FD) is an uncommon initial manifestation of nerve root compression secondary to acute lumbar disc herniation not associated with low back pain and radiculopathy. In most patients with lumber disc herniation, FD is unilateral and is associated with low back pain and leg pain. Few cases have been described as bilateral FD, occurring simultaneously. Chronic bilateral foot drop as a sequela of systemic illnesses has been well-studied; however, acute painless bilateral foot drops not associated with radiculopathy or back pain in a healthy person should be immediately investigated, cauda equina syndrome is not necessarily to be associated with acute bilateral foot drop as shown in our case here. This study highlights the unusual presentation of lumber disc prolapse and illustrates the importance of palsy duration, early diagnosis, and time to surgery as predicting factors for improvement. The author presents bilateral acute foot drop case associated with lumbar discopathy without back pain, radiculopathy, or cauda equina symptoms as an unusual initial manifestation of lumbar discopathy. The current study aimed to provide insight on the lumbar acute painless etiology of bilateral FD in a patient without radiculopathy and back pain to prevent functional loss. Moreover, it emphasized the rare initial manifestations of lumbar disc prolapse and the importance of predictive factors of improvement such as palsy duration, early diagnosis, and time to surgery. To illustrate work-up for bilateral foot drop in acute setting presentation. A systematic review was conducted using PubMed and google scholar. Demographic and radiological data were obtained from a painless acute bilateral foot drop presented to our neurosurgery unit. We reviewed the patient demographics, clinical presentation, radiological parameters, surgical parameters, and time from presentation to surgery. In addition, preoperative, early postoperative, and most recent follow-up neurological examinations were compared. Our patient improved gradually after the surgery, on the first postoperative day, we obtained an MMT (Manual Muscle Test) Scoring < 3 on admission, and third day postoperative MMT Scoring of 3. After six weeks, the last follow-up had an MMT Score of 5 for both ankles.},
 year = {2022}
}

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