There can be no doubt: patients who have the misfortune to suffer from a paralyzing lumbar disc herniation must be operated upon immediately. An uncertainty remains however : what is the matter of urgency for this surgical intervention? The neurosurgeons of the University Hospital of Liege have been trying to find the answer to this question. Even though the study was unable to demonstrate the influence of the deadline, it shows that the rapidity of surgical intervention does not guarantee recovery in all patients. This means that patients can no longer be guaranteed that they have a better chance of recovery because they undergo an urgent operation.

This story began when a thirty-year old woman came under the care of the University Hospital of Liege one Friday afternoon. At the time, she was probably thinking of only three things: her pain, her inability to walk “normally”, and the preparations for the dinner organized in honor of her daughter’s communion two days later. Obviously, the patient could not have guessed that her “case” would become the subject of an end-of-study thesis by a physiotherapy graduate, Sarah Borlon, and later, an article based on this work supervised by Dr. Annie Dubuisson, clinical head in the Department of Neurosurgery of the University Hospital of Liege and co-signed, among others, by Prof. Didier Martin, head of the Department of Neurosurgery at the University Hospital of Liege and senior lecturer at the University of Liege (1).

“The diagnosis was clear”, explains, Dr. Annie Dubuisson. “It was a paralyzing lumbar disc herniation. This means that in the spinal canal, a hernia compresses a nerve and causes a motor deficit. In this case the deficit was very marked in the foot during walking. Due to the fact that a nerve was squeezed, the muscle that makes it possible to lift the foot was weakened, so much so that when attempting to move forward the foot strikes the ground because it is impossible to lift the foot normally. When faced with ‘foot drop’ of this sort, the surgical indication is very clear: It is imperative to decompress the nerve. We believe, as do many other neurosurgeons, that it is necessary to decompress the nerve as soon as possible".


However, when confronted with this type of pathology, one question needs to be answered: what is the level of urgency with regard to such an operation? Is it absolutely necessary to operate on the patient immediately, or can the operation be delayed slightly without damaging motor recovery? In the story we are concerned with here, operating on the woman on the Monday rather than the Saturday would have enable her to attend her daughter’s communion party. While there could be no doubt that the operation should be carried out immediately, no recommendation based on “evidence-based medicine” (based on scientific proof) has yet established the optimal moment for carrying out such an operation. By intervening as quickly as possible, can we enable patients to completely recover the use of their foot or damaged organ? Clearly, such an argument would make a difference…

On the Friday, Dr. Dubuisson informed the patient about the current state of scientific knowledge and about any doubts concerning the rapidity of the operation to be carried out. She then allowed the patient to choose between an operation scheduled for the next day or the following Monday. It was also at this precise moment that Sarah Borlon was entrusted with the project of carrying out a study on the delicate question of how a delay in operating could affect the patient’s prognosis.

When the back suffers  

Back pain is far from being a rare pathology: 80 % of Belgians experience the “joys” of this problem at least once in their lives, for the simple reason that this part of the body experiences wear and tear due to the high extent to which it is solicited in daily life. Low back pain, lumbago and sciatica (due to the compression and irritation of a nerve root in the region of the sciatic nerve) can occur. “In the majority of cases, these low back pain or lumbosciaticas episodes recede spontaneously, in a few days or weeks with a reduction in inflammation”, points out Prof. Didier Martin.

1) Paralyzing lumbar disc herniation: a surgical emergency? Reflections on a series of 24 patients and data from the literature. A. Dubuisson, S.Borlon, F. Scholtes, T.Racaru, D. Martin.