• S Waseem, J Kyriakides, A R Amiri, R Shetty, N Shetty, and R Chammaa.
• Department of Trauma and Orthopaedics, The Whittington Hospital, Magdala Avenue, London, UK. saimawaseem@doctors.org.uk.
• Eur Spine J. 2023 Apr 1; 32 (4): 109911051099-1105.

PurposeFoot drop can uncommonly be a painless presenting symptom of degenerative spinal disorders. This systematic review aimed to summarise the literature on the management and outcomes of patients with a painless foot drop.MethodsWe performed a systematic review of PubMed, EMBASE and Medline according to PRISMA guidelines. All studies published after 1980 in English referring to adult patients with a painless foot drop were included. Exclusion criteria included opinion based reports, review articles and articles in which foot drop was not caused by degenerative pathology of the thoracolumbar spine.ResultsOf 62 included patients, 30 (48.4%) were male with an average age of 48.7 years (range 27-84). The mean duration of symptoms was 69.0 days (1-700). 98.8% were managed operatively. 46 (74.2%) patients had symptomatic improvement, with 41 (66.1%) having a post-intervention MRC power grading of 3 or above. Patients with a pre-procedure MRC 0 had a higher median increase in MRC post-procedure than those with MRC > 0. Of two studies comparing painful and painless symptoms, painless foot drop patients were less likely to recover to MRC equal to or over 3 than those with painful symptoms OR 0.31 (95% CI 0.04-2.65).ConclusionThis systematic review and meta-analysis demonstrates a role for surgery in facilitating the neurological recovery of patients with a painless foot drop. Large randomised controlled studies are required to characterise the role of operative intervention in these patients and compare outcomes between patients with painless and painful foot drop.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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