Spontaneous regression of herniated nucleus pulposus

Abstract

Lumbar disc hernia is common disease, affecting about 5% of the population. Many studies to date reported regression of disc herniation without surgical intervention. Medical records of the patients who applied to the spine clinic in an outpatient setting were retrospectively reviewed. Age, sex, radiological findings, neurological examinations, and medical treatments of the patients were evaluated. Male patients constituted 52.6% of the cases (n = 40) and 47.4% (n = 36) were female. The ages of the patients ranged from 25 to 82 years, with a mean of 48.5 ± 12.1 years. Visual analog scale (VAS) measurements ranged from 0 to 8 and the mean was determined as 2.65 ± 1.98. The VAS score of pain severity of 12 (15.78%) cases was 0, VAS score of 39 (51.31%) cases was 1 to 3, VAS score of 20 (26.31%) cases was 4 to 6, VAS score of 5 (6.57%) cases was 7 to 10. Eighteen (23.68%) of the cases underwent neuropathic pain treatment for more than 6 months. Fifteen (19.7%) patients also developed permanent motor deficits. Findings of our study show that there was no direct association between radiological improvement and clinical improvement. Indication for surgery still existed in a high number of patients, substantial of which developed permanent motor deficits. Current results suggest that we need to advise our patients in favor of early surgery as soon as indication for surgery is established upon neurological and radiological examination.

Clinical and Radiologic Analysis of Disc Heights Change in Conservatively Treated Lumbar Herniated Disc Patients

“…Three hypotheses have been proposed in the literature. First, the prolapsed intervertebral disc returns to the intervertebral disc space by a healthy PLL 13) . Second, the size of the intervertebral disc is reduced and resolved by gradual dehydration and contraction, Third, the herniated intervertebral disc causes immunologic, biochemical responses and neovascularization, which results in phagocytosis and enzymatic degradation of cartilage tissue 12,13) .…”

“…First, the prolapsed intervertebral disc returns to the intervertebral disc space by a healthy PLL 13) . Second, the size of the intervertebral disc is reduced and resolved by gradual dehydration and contraction, Third, the herniated intervertebral disc causes immunologic, biochemical responses and neovascularization, which results in phagocytosis and enzymatic degradation of cartilage tissue 12,13) . Among them, the most recently noted hypothesis of spontaneous resolution is that intervertebral disc tissue is absorbed by immune responses and neovascularization, which be inferred from the rim enhancement of end plate of disc space on the Gadolinium-enhanced MRI in patients with a lumbar herniated disc 3,13) .…”

Spontaneous resorption of large thoracic disc herniation: A case report

“…Skorašnja studija koju su sproveli Turk i saradnici pokazala je da je, uprkos radiološkom poboljšanju, indikacija za hiruršku intervenciju još uvek postojala kod visokog broja pacijenata sa hernijacijom lumbalnog diska, od kojih je značajan deo pokazao razvoj trajnih motornih deficita [22]. Situacija je, međutim, složenija kada je u pitanju torakalna regija.…”

“…A recent study by Turk et al showed that despite radiological improvement, indication for surgery still existed in a high number of patients with lumbar disc herniation, a substantial share of which developed permanent motor deficits [22]. However, the situation is more complex in the thoracic region.…”

Risk factors for disc height loss in conservatively treated symptomatic lumbar disc herniation in elderly patients

“…There were no differences in back pain between not-changed disc height patient and decreased disc height patient. To date, the relationship between disc height reduction or disc degeneration and back pain remains unclear [11,16]. In addition to discussing with patients about the options of conservative treatment for herniated lumbar disc, it is necessary to explain that herniated lumbar disc itself can cause a decrease of disc height and chronic back pain due to degenerative changes in the intervertebral disc.…”