Epidural Steroid Injection Might Advance Clinical and Electrophysiology Outcomes among Drop Foot Patients due to LDH Underwent of Transforaminal Microdiscectomy: A Prospective Study

Trianggoro Budisulistyo; Retna Putri; Amin  Husni; Dodik  Tugasworo; Endang  Kustiowati; Dwi  Pudjonarko

doi:10.3889/oamjms.2023.11676

Authors

Trianggoro Budisulistyo Department of Neurology, Diponegoro University, Dr. Kariadi Hospital, Semarang, Indonesia
Retna Putri Department of Neurology, Diponegoro University, Dr. Kariadi Hospital, Semarang, Indonesia
Amin Husni Department of Neurology, Diponegoro University, Dr. Kariadi Hospital, Semarang, Indonesia
Dodik Tugasworo Department of Neurology, Diponegoro University, Dr. Kariadi Hospital, Semarang, Indonesia
Endang Kustiowati Department of Neurology, Diponegoro University, Dr. Kariadi Hospital, Semarang, Indonesia
Dwi Pudjonarko Department of Neurology, Diponegoro University, Dr. Kariadi Hospital, Semarang, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2023.11676

Keywords:

Lumbar disc herniation, Drop foot, Microdiscectomy, Epidural steroid, Electrodiagnostic

Abstract

BACKGROUND: Drop foot can be caused by degenerative disorders affected at L4-5 (20%), L5-S1 (41.5%), or isolated L5 (25.2%), whereas 68% of cases are caused by peripheral neuropathy (18.3%) and peroneal neuropathy (31%). The Lumbar disc herniation (LDH) might cause compression and/or neuropathic problems.

AIM: We aimed to investigate how epidural steroid injection might advance clinical and electrophysiology outcomes among drop foot patients due to LDH underwent of transforaminal microdiscectomy.

METHODS: Nine subjects (4 females, 5 males), aged between 35 and 77 years old (mean 56 + 4), suffered from drop feet due to LDH for 5–18 months following traumatic experiences. Four subjects had prescribed diabetic problems, four were normal or overweight, and one was obese.

RESULTS: After 3 months of OS study, the NRS score improved (29–58.5%), while the Manual motor test varied. Subject #8, whose age is 77 years old, showed clinically bilateral drop feet; and four subjects (#2, #5, #6, #8) suffered from diabetes. Regarding the BMI in the presence of overweight or obesity, there are four subjects each, whereas the normal weight has only one (subject #5). Obese subjects showed no sign of motor improvement (20–25%), whereas pain improvement was in the range of 25–50%. The removal of disc volume is about 0.5–1 cc (mean 0.722 + 0.2), while the diameter is reduced in the range 4.3–10.99% (mean 8.63% + 2.36).

DISCUSSION: Drop feet due to LDH in accordance to bring inflammation and structural problems, so transforaminal microdiscectomy is aimed at nerve decompression and managing the internal annular layers. Blocked dorsal root ganglions might improve the clinical syndromes with regard to the nociceptive and neuropathic pain that interfere. Electromyography might examine the radiculopathies but cannot distinguish between neuropathies and myopathies clearly.Age, body weight, onset, presurgical motor strengths, level of involvement, either neuropathy or diabetes in association with the prognosis.

CONCLUSION: Decompression procedures are important for treating drop foot patients when herniated discs are he main problem.

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