Spondylolisthesis foot drop usually occurs due to compression of the L5 nerve root created by central or neuroforaminal stenosis which is enacted by the vertebral migration issue. Spondylolisthesis most often occurs at the lumbosacral juncture of L5, but can also occur at L4 in some patients. In truth, listhesis can occur virtually anywhere in the spinal column, but the above 2 locations certainly represent the most commonly affected vertebral levels. Both of these locations can threaten the integrity of the L5 nerve root through structural compression within the central spinal canal or as the nerve exits the neuroforaminal opening.
This essay investigates how spondylolisthesis can cause foot drop, also known as dorsiflexion deficit, through structural compression of the L5 nerve root, leading to innervation problems in the tissues that allow elevation of the frontal foot.
Spondylolisthesis Foot Drop Explained
Foot drop describes the inability to elevate the frontal foot, creating noticeable deficits in the ability to ambulate and utilize the affected foot for any strenuous activity. The characteristic presentation includes drooping of the frontal foot, deficient strength, dragging the foot or stubbing the toes while walking and the complete inability to stand on the heel on the affected side.
Neurological exam will be able to diagnose foot drop, compared to other potentially similar conditions. Since the root cause might be linked to spondylolisthesis causation, we always recommend seeking out diagnostic evaluation from a specialist in spinal neurology for best and most efficient results.
Spinal Foot Drop Causes
Dorsiflexion deficit is a diagnosis made in association with many back pain conditions. Any process that has the ability to compromise the structural integrity or functionality of the spinal nerve roots at L4 and L5, the sciatic nerve, or select peripheral branches of the sciatic nerve, has the capacity to enact foot drop. Spondylolisthesis can create foot drop through several possible scenarios including any of the following examples:
Listhesis can misalign the central spinal canal, potentially creating cauda equina syndrome in the lower back or spinal cord compression in the neck. These conditions can affect the spinal nerve roots that innervate the frontal foot or the spinal cord tracts that eventually form these vital neurological roots.
Lumbar spondylolisthesis can impinge one or more of the lumbar nerve roots within their respective foraminal openings due to vertebral shift and misalignment. A pinched nerve at L5 is the most common culprit, although L4 might be to blame in select patient profiles.
Spondylolisthesis can cause changes in posture and gait that can influence the functionality of the piriformis muscle. If the muscle becomes traumatized or unbalanced, piriformis syndrome might result, with the sciatic nerve being compressed. Foot drop might be an uncommon result.
Mindbody pain syndromes often exist in cases of incidental spondylolisthesis. These ischemia conditions can undermine the integrity of the spinal nerves, spinal cord or sciatic nerve in much the same manner as structural compression and are enacted completely due to psychogenic reasons.
Spondylolisthesis Foot Drop Treatment
Treatment for foot drop that is created by vertebral listhesis can only usually be resolved by addressing the vertebral migration using invasive spondylodesis surgery. Spinal fusion has many risks, but is still the only true way to correct listhesis in the spine and relieve pressure off compressed nerve tissues. Conservative care is unlikely to provide much relief for foot drop deficits, although the condition does have a reasonable chance of resolving organically in a minority of patients.
It should be noted that many spondylolisthesis symptoms are actually the result of mindbody syndromes and not the consequence of any spinal abnormality. We see this iatrogenic misdiagnosis often and one of the possible expressions of mindbody ischemia is foot drop. Treating listhesis in these cases will be completely unfulfilling, since the vertebral migration is not the true cause of neurological dysfunction. Instead, the underlying oxygen deprivation syndrome must be rooted out using knowledge therapy, as this is the accepted gold standard treatment for mindbody-enacted primary gain pain conditions.