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Neurospine. 2020 Jan 26. doi: 10.14245/ns.1938368.184. [Epub ahead of print]

Lower Extremity Motor Deficits Are Underappreciated in Patient-Reported Outcome Measures: Added Value of Objective Outcome Measures.

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Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.
Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Department of Neurosurgery, Ernst von Bergmann Hospital, Potsdam, Germany.
Division of Neurosurgery, Department of Clinical Neuroscience, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Neuro- and Spine Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland.



The patient-reported outcome measure (PROM)-based evaluation in lumbar degenerative disc disease (DDD) is today's gold standard but has limitations. We studied the impact of lower extremity motor deficits (LEMDs) on PROMs and a new objective outcome measure.


We evaluated patients with lumbar DDD from a prospective two-center database. LEMDs were graded according to the British Medical Research Council (BMRC; 5 (normal) - 0 (no movement). The PROM-based evaluation included pain (VAS), disability (ODI & RMDI) and health-related quality of life (hrQoL; SF-12 PCS/MCS & EQ-5D index). Objective functional impairment (OFI) was determined as age- and sex-adjusted Timed-Up and Go (TUG) test value.


One-hundred and five of 375 patients (28.0%) had a LEMD. Patients with LEMD had slightly higher disability (ODI 52.8 vs. 48.2, p=0.025; RMDI 12.6 vs. 11.3, p=0.034) but similar pain and hrQoL scores. OFI T-scores were significantly higher in patients with LEMD (144.2 vs. 124.3, p=0.006). When comparing patients with high- (BMRC 0-2) vs. low-grade LEMD (BMRC 3-4), no difference was evident for the PROM-based evaluation (all p>0.05) but patients with high-grade LEMD had markedly higher OFI T-scores (280.9 vs. 136.0, p=0.001). Patients with LEMD had longer TUG test times and OFI T-scores than matched controls without LEMDs.


Our data suggest that PROMs fail to sufficiently account for LEMD-associated disability, which is common and oftentimes bothersome to patients. The objective functional evaluation with the TUG test appears to be more sensitive to LEMD-associated disability. An objective functional evaluation of patients with LEMD appears reasonable.


Disability; Foot drop; Lumbar degenerative disc disease; Motor deficit; Objective functional impairment; Paresis; Patient-reported outcome measure

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