The deadline between the appearance of the deficit and the surgical intervention was also known: it rose to an average of 20 days, because a majority of patients had first been treated in a conservative manner (with anti-inflammatories for 15 of them, physiotherapy for 4 of them and peridural injections in 5 cases). Between the date of consultation at the hospital and that of the intervention, the duration was not higher than 2 days for 9 of the patients. The duration was 3 to 8 days for 9 others, and higher than 9 days for the remaining 6 patients. The patients who were operated on left hospital between 2 and 11 days after the intervention (4.4 days on average). Only two of them were then transferred to a re-education center, the others being able to return home.

The best way to walk

During post-operation hospitalization, 2 patients fully recovered from their motor deficit. At this stage, the recovery was partial for 14 other individuals and non-existent for the others. Among them, 2 patients left the hospital with Codivilla foot orthoses. “It is an L-shaped splint. Worn the entire length of the leg and under the foot, it assists in stepping, when the foot slams down with each step or when the patient is obliged to raise the knee and bend at the hip in order to advance while expecting a later recovery from the deficit”, explains Dr. Annie Dubuisson.

The clinical assessment conducted on average 20 weeks after the operation showed that the back problems present (due to an LDH) had entirely disappeared or improved greatly among the patients. With regard to the neurological deficit, 17 recovered well (71%). This means that they could lead normal lives, without limitations both in their personal and professional lives. But this was not the case for the 7 other individuals who did not see their deficit disappear or only saw a slight improvement.

The two groups of patients - those for whom the operation had been a success, and the less fortunate ones – were evidently compared by the authors of the article in order to attempt to detect what might cause the scales to weigh one way rather than another. This statistical analysis did not make it possible to show a statistically significant difference concerning, among other factors, gender, profession, body mass index or the presence of previous back problems. Type 2 diabetes which usually has a negative influence on recovery due to a weakening of the nerves did not seem to have an impact on the patients concerned.

The 17 individuals who saw a favorable improvement were, on average, more than ten years older than the others. This result clearly astonished the authors of the study. In addition, the authors remain prudent or circumspect with regard to one of their results: strangely, regular consumption of alcoholic drinks seemed to be among the influences favoring motor recovery. In fact, the reduced number of cases could explain these unexpected observations.

The time factor

“The objective of our study was to analyze the prognostic factors of paralyzing LDH recovery and, in particular, the operation deadline”, Dr. Annie Dubuisson reminds us. In practice, ¾ of patients operated on within two days of the appearance of the deficit saw a favorable development…but 14 of the 20 patients who had their operation later obtained the same result. On this point the authors have not found any statistically significant difference concerning the duration and apparition of the deficit and surgical intervention.