Lumbar disc herniation with moderate-to-severe motor deficit: A multicenter real-world study

To describe patient outcomes and associated factors after surgical treatment for lumbar disc herniation (LDH) with motor deficit.

A prospective observational study was conducted of all patients with LDH and motor deficit treated in one of nine centers in France between August 2023 and April 2024. The inclusion criteria were age ≥ 18 years, a Medical Research Council (MRC) muscle strength score ≤ 3 out of 5 in at least one muscle group, absence of spondylolisthesis and absence of scoliosis. Clinical evaluations were performed preoperatively, on day 1 after surgery and at 1-3 and 10-12 months' follow-up. The main outcome variable was complete motor recovery (MRC score = 5).

Eighty-three of the 144 included patients (58%) had complete motor recovery. Complete motor recovery was independently associated with earlier treatment (odds ratio (OR) [95% confidence interval], 0.73 [0.57 to 0.91] per 10 day increase) less severe preoperative weakness (OR, 6.0 [1.8 to 21.8] for MRC score ≥ 2 vs. < 2), day 1 postoperative resolution of radicular pain (OR, 2.5 [1.1 to 6.1] for pain score = 0 vs. > 0) and day 1 gains in muscle strength (OR, 6.9 [2.7 to 19.4] for increase in MRC score vs. no increase). Complete motor recovery was significantly associated with sensory recovery.

The strongest predictor of complete motor recovery after surgery for LDH was day 1 postoperative improvement in muscle strength. This prognosis was also associated with lower postoperative radicular pain, shorter time to treatment, higher preoperative muscle strength. These results can help inform clinicians and patients on likely outcomes after LDH surgery.