Lumbar Disc Herniation

Delauche-Cavallier, Marie-Christine; Budet, C; Laredo, Jean‐Denis; Debie, Bruno; Wybier, M; Dorfmann, H; Ballner, Ingrid

doi:10.1097/00007632-199208000-00010

Cited by 115 publications

(6 citation statements)

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“…The symptoms of radicular pain can also disappear after conservative therapy without a corresponding decrease in the volume of the herniated disc. [48][49][50] Similarly, only weak correlations exist between the severity of central and lateral recess stenosis, and pain and functional disability, 51 which is confirmed by the Minimal Invasive Spine Treatment (MIST) guidelines. 52 If the clinical picture is unclear or there is a lack of radiological correlation, electromyography (EMG) and nerve conduction studies (NCS) can be performed to differentiate lumbar radicular syndrome from peripheral neuropathy (sensitivity 0.45 to 0.65).…”

Section: Imaging Studiesmentioning

confidence: 79%

“…There is also little correlation between the severity of a pain and the magnitude of a spinal disk herniation, with approximately one‐third of patients with clinical LSR showing no nerve root compression on imaging. The symptoms of radicular pain can also disappear after conservative therapy without a corresponding decrease in the volume of the herniated disc 48–50 . Similarly, only weak correlations exist between the severity of central and lateral recess stenosis, and pain and functional disability, 51 which is confirmed by the Minimal Invasive Spine Treatment (MIST) guidelines 52 .…”

Section: Diagnosismentioning

confidence: 94%

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1. Lumbosacral radicular pain

Peene,

Cohen,

Kallewaard

et al. 2023

Pain Practice

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IntroductionPatients suffering lumbosacral radicular pain report radiating pain in one or more lumbar or sacral dermatomes. In the general population, low back pain with leg pain extending below the knee has an annual prevalence that varies from 9.9% to 25%.MethodsThe literature on the diagnosis and treatment of lumbosacral radicular pain was reviewed and summarized.ResultsAlthough a patient's history, the pain distribution pattern, and clinical examination may yield a presumptive diagnosis of lumbosacral radicular pain, additional clinical tests may be required. Medical imaging studies can demonstrate or exclude specific underlying pathologies and identify nerve root irritation, while selective diagnostic nerve root blocks can be used to confirm the affected level(s).In subacute lumbosacral radicular pain, transforaminal corticosteroid administration provides short‐term pain relief and improves mobility. In chronic lumbosacral radicular pain, pulsed radiofrequency (PRF) treatment adjacent to the spinal ganglion (DRG) can provide pain relief for a longer period in well‐selected patients. In cases of refractory pain, epidural adhesiolysis and spinal cord stimulation can be considered in experienced centers.ConclusionsThe diagnosis of lumbosacral radicular pain is based on a combination of history, clinical examination, and additional investigations. Epidural steroids can be considered for subacute lumbosacral radicular pain. In chronic lumbosacral radicular pain, PRF adjacent to the DRG is recommended. SCS and epidural adhesiolysis can be considered for cases of refractory pain in specialized centers.

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Section: Imaging Studiesmentioning

confidence: 79%

Section: Diagnosismentioning

confidence: 94%

1. Lumbosacral radicular pain

Peene,

Cohen,

Kallewaard

et al. 2023

Pain Practice

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“…Since Barkow 20 first reported the formation of highly vascular scar tissue around sites of herniation in 1841, there have been many reports of spontaneous regression of herniation based on autopsy findings, 21 surgical specimens, [22][23][24] CT, 10,11,[25][26][27] and MRI. 11,[13][14][15][16][17] The rich vascular network in the posterior longitudinal ligament and posterior margin of the vertebral body is thought to play a major role in the spontaneous regression of LDH.…”

Section: Discussionmentioning

confidence: 99%

Ultrastructural Analysis on Lumbar Disc Herniation Using Surgical Specimens

Kobayashi¹,

Meir²,

Kokubo³

et al. 2009

Spine

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“…Lee et al [21] reported the highest LDH resorption (96%) with an average follow-up of 341 days, indicating that we should take the likelihood of LDH regression seriously. Delauche-Cavallier [22] reported a resorption rate id of 67% with an average follow-up time of 12.5 months. Matsubara [23] reported a rate of 62% with an average follow-up time of 9.7 months.…”

Section: Discussionmentioning

confidence: 98%

Clinical recovery in Spontaneous lumbar disc resorption may alter the decision of lumbar disc surgery in the future.

Abu Elfadle,

Khoudir,

Soliman

et al. 2024

Medicine Updates

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Background: Different processes have been proposed in the literature to explain the spontaneous resorption of herniated lumbar discs, and numerous studies have found numerous resorption-predictive features. The goal of this study was to assess the clinical improvement and correlation with radiological resorption of lumbar disc herniation (LDH) hence we can decide appropriate time for conservative management. Materials and methods: 18 patients who had LDH on initial magnetic resonance imaging (MRI) were included in this retrospective analysis. The average age was 36.9 ± 7.2 years, with eleven cases predominantly male. A total of 100% of the patients had sciatica, and 55.6% had pain in their lower backs. Since none of the patients underwent surgery, they were all given conservative care. For 8 to 11 months, patients were followed up clinically and radiologically (using an MRI) in the outpatient clinic. Results: 44.4% of patients had L5-S1 disc prolapse whereas 55.6% had L4-5 level affected. Sequestration affected 66.7% while Extruded disc was seen in 33.3%. Conservative management revealed that 66.11 % underwent spontaneous resorption of the ruptured disc in a mean time of 9.2 ± 1.1 months as seen radiologically in the MRI. Clinical improvement occurred in all patients in a mean of 5.9 ± 1.2. Conclusion: Spontaneous resorption of a herniated lumbar disc, which can happen due to retraction, dehydration, or an inflammatory-mediated mechanism, has become a more common event in lumbar disc prolapse. Clinical recovery typically occurred prior to LDH radiological improvement. The clinical resolution of symptoms and the radiological resolution of LDH were not shown to be significantly correlated.

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Lumbar Disc Herniation

Cited by 115 publications

References 0 publications

1. Lumbosacral radicular pain

1. Lumbosacral radicular pain

Ultrastructural Analysis on Lumbar Disc Herniation Using Surgical Specimens

Clinical recovery in Spontaneous lumbar disc resorption may alter the decision of lumbar disc surgery in the future.

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