Spontaneous Resorption of Herniated Lumbar Disk: Observational Retrospective Study in 9 Patients

Elkholy, Ahmed Rizk; Farid, Ashraf Mohamed; Shamhoot, Ebrahim Ahmed

doi:10.1016/j.wneu.2018.12.115

Cited by 8 publications

(5 citation statements)

References 26 publications

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“…The results of our study show that there is no relationship between a patient's likelihood of eventually requiring surgery after trying conservative therapy and the degree of a lumbar disc herniation. This is in line with research by Benson et al [15] that found that severe disc herniations can be managed effectively conservatively but contradicts findings by Elkholy et al [16] and Autio RA et al [17] who demonstrated that larger herniated discs spontaneously resorbed more quickly than smaller discs.…”

Section: Discussionsupporting

confidence: 85%

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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Section: Discussionsupporting

confidence: 85%

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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“…Specifically, multiple studies have reported no association between initial herniation measurements, whereas others found larger initial herniation measurements to be associated with a shorter time to resorption. [35][36][37] While the results of the current study cannot be directly compared with those of previous works, we determined no difference in time to resorption between single-level and multilevel LDH groups, supporting the notion that initial herniation measurements are not related to time to resorption.…”

Section: Clinical Case Seriessupporting

confidence: 79%

How Does Resorption Differ Among Single-Level and Multilevel Lumbar Disc Herniations? A Prospective Multi-Imaging and Clinical Phenotype Study

Hornung,

Rudisill,

Barajas

et al. 2024

Spine

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Study Design. Prospective, Case Series. Objective. To identify and characterize any differences in specific patient factors, MRI findings, features of spontaneous disc resorption, and outcomes between patients with single- and multi-level LDH. Background. Lumbar disc herniation (LDH) is one of the most common spinal pathologies worldwide. Though many cases of LDH resolve by spontaneous resorption, the mechanism underlying this “self-healing” phenomenon remains poorly understood, particularly in the context of multi-level herniations. Methods. A one-year prospective study was conducted of patients presenting with acute symptomatic LDH between 2017 and 2019. Baseline demographics, herniation characteristics, and MRI phenotypes were recorded prior to treatment, which consisted of gabapentin, acupuncture, and avoidance of inflammatory-modulating medications. MRIs were performed approximately every 3 months after initial evaluation to determine any differences between patients with single- and multi-level LDH. Results. Ninety patients were included, 17 demonstrated multi-level LDH. Body mass index was higher amongst patients with multi-level LDH (P<0.001). Patients with multi-level LDH were more like to exhibit L3/L4 inferior endplate defects (P=0.001), L4/L5 superior endplate defects (P=0.012), and L4/L5 inferior endplate defects (P=0.020) on MRI. No other differences in MRI phenotypes (e.g., Modic changes, osteophytes, etc.) existed between groups. Resorption rate and time to resolution did not differ between those with single- and multi-level LDH. Conclusions. Resorption rates were similar between single- and multi-level LDH at various time points throughout one prospective assessment, providing insights that disc healing may have unique programmed signatures. Compared to those with single-level LDH, patients with multi-level herniations were more likely to have a higher BMI, lesser initial axial and sagittal disc measurements, and endplate defects at specific lumbar levels. In addition, our findings support the use of conservative management in patients with LDH regardless of the number of levels affected.

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“…Young and middle-aged patients have a high probability of resorption. [ 11 , 12 ] Advanced age is not conducive to resorption owing to serious intervertebral disc degeneration, loss of water in the intervertebral disc tissue, and thickened annulus fibrosus. [ 13 ]…”

Section: Discussionmentioning

confidence: 99%

Non-surgical treatment of giant tumor-like lumbar disc herniation based on enhanced MRI: A case series

et al. 2023

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Rationale: In recent clinical follow-up, it has been vertified that resorption in lumbar disc herniation (LDH) could be of great curative effect in non-surgical treatment for LDH. However, reports of resorption in giant tumor-like LDH are rarely mentioned due to its risk of irreversible neurological damage which could be caused by long-term non-surgical treatment. In our clinical observations, we have found that enhanced MRI helps to distinguish LDH from intradural tumours and to predict the probability of resorption in LDH. We analyzed 8 patients with giant tumor-like LDH who underwent non-surgical treatment, and these patients had resorption during follow-up. All patients were examined with enhanced MRI before treatment, and the type of “bull’s eye” sign classification was determined by images. The MRI protrusion volume(VP), resorption rate(HR%) and JOA score of patients at the first visit and the last follow-up were recorded. Patient concerns: 8 patients of Han ethnicity were admitted to the department of orthopedic complaining of low back pain for 1week to 12months. They were diagnosed with giant tumor-like LDH by enhanced MRI. Diagnoses: These patients were diagnosed with giant tumor-like LDH. Interventions: We adopted a non-surgical treatment plan for the patients, including taking oral non-steroidal anti-inflammatory agents and performing rehabilitation exercise. In consideration of the risk of irreversible neurological damage, patients were closely observed during treatment and follow-up. Once the following conditions occur, surgical treatment is required immediately: The symptoms are not signifcantly relieved after 3 to 6 months of non-surgical treatment; The symptoms are aggravated by non-surgica treatment; The clinical manifestations of cauda equina syndrome. Outcomes: After treated with oral non-steroidal anti-inflammatory agents and rehabilitation exercise, the resorption was accompanied by clinical symptom relief. No neurological damage occurred in all patients, and the clinical symptoms did not recur in the subsequent follow-up. Lessons: Clinicians should fully consider the possibility of resorption prior to surgical treatment in patients with giant LDH. We can predict the probability of resorption in patients with giant LDH based on enhanced MRI. For patients with a high probability of resorption, we can choose non-surgical treatment in the absence of progressive neurological impairment and cauda equina syndrome.

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Spontaneous Resorption of Herniated Lumbar Disk: Observational Retrospective Study in 9 Patients

Cited by 8 publications

References 26 publications

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

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

How Does Resorption Differ Among Single-Level and Multilevel Lumbar Disc Herniations? A Prospective Multi-Imaging and Clinical Phenotype Study

Non-surgical treatment of giant tumor-like lumbar disc herniation based on enhanced MRI: A case series

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