Spontaneous Regression of Extruded Lumbar Disc Herniation: Correlation with Clinical Outcome

Overview

Journal Pak J Med Sci

Specialty General Medicine

Date 2019 Aug 3

PMID 31372127

Citations 13

Authors

Bilge Kesikburun

Emel Eksioglu

Aynur Turan

Emre Adiguzel

Serdar Kesikburun

Aytul Cakci

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the natural history of lumbar extruded disc with conservative treatment on MRI and to assess relation between the radiologic changes and clinical outcome.

Methods: This prospective observational study was conducted at University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital between May 2015-June 2018. It included consecutive patients who were diagnosed as having lumbar symptomatic extruded disc as shown in MRI. After an average period of 17.0±7.2 months, repeat MRI was taken in 40 patients who received only conservative care during follow-up. Changes in the volume of herniated disc was measured. The patients were assigned into 3 groups as follow: (1) non-regression, (2) partial-regression, and (3) complete resolution. Numeric Rating Scale (NRS) pain score, the Oswestry Low Back Pain Disability Index (ODI) and muscle weakness were evaluated.

Results: Based on disc volume of the T2-weighted MR images; four patients (10%) did not show any regression, six patients (15%) had a partial regression, and 30 patients (75%) had a complete resolution. Patients with complete resolution showed a significant improvement in the NRS pain score and the ODI score (p<0,001) over time. In patients with partial regression, only the ODI score improved significantly (p=0,043). Non-regression group did not show any improvement in any clinical outcome measure (p>0,05). Changes in the NRS scores over time were significantly higher in complete resolution group compared to non-regression group (p=0.016).

Conclusion: The majority of the patients with extruded lumbar disc herniation might have reduction in size of herniated disc in the long run along with improvement in symptoms and function with conservative care.

Citing Articles

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References

Ahn S, Ahn M, Byun W . Effect of the transligamentous extension of lumbar disc herniations on their regression and the clinical outcome of sciatica. Spine (Phila Pa 1976). 2000; 25(4):475-80. DOI: 10.1097/00007632-200002150-00014. View

Ahn S, Park H, Byun W, Ahn M, Bae J . Comparison of clinical outcomes and natural morphologic changes between sequestered and large central extruded disc herniations. Yonsei Med J. 2002; 43(3):283-90. DOI: 10.3349/ymj.2002.43.3.283. View

Takada E, Takahashi M, Shimada K . Natural history of lumbar disc hernia with radicular leg pain: Spontaneous MRI changes of the herniated mass and correlation with clinical outcome. J Orthop Surg (Hong Kong). 2002; 9(1):1-7. DOI: 10.1177/230949900100900102. View

Bush K, Cowan N, Katz D, Gishen P . The natural history of sciatica associated with disc pathology. A prospective study with clinical and independent radiologic follow-up. Spine (Phila Pa 1976). 1992; 17(10):1205-12. DOI: 10.1097/00007632-199210000-00013. View

Yakut E, Duger T, Oksuz C, Yorukan S, Ureten K, Turan D . Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine (Phila Pa 1976). 2004; 29(5):581-5. DOI: 10.1097/01.brs.0000113869.13209.03. View

Kato T, Haro H, Komori H, Shinomiya K . Sequential dynamics of inflammatory cytokine, angiogenesis inducing factor and matrix degrading enzymes during spontaneous resorption of the herniated disc. J Orthop Res. 2004; 22(4):895-900. DOI: 10.1016/j.orthres.2003.11.008. View

Bozzao A, Gallucci M, Masciocchi C, Aprile I, Barile A, Passariello R . Lumbar disk herniation: MR imaging assessment of natural history in patients treated without surgery. Radiology. 1992; 185(1):135-41. DOI: 10.1148/radiology.185.1.1523297. View

Atlas S, Keller R, Wu Y, Deyo R, Singer D . Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the maine lumbar spine study. Spine (Phila Pa 1976). 2005; 30(8):927-35. DOI: 10.1097/01.brs.0000158954.68522.2a. View

Autio R, Karppinen J, Niinimaki J, Ojala R, Kurunlahti M, Haapea M . Determinants of spontaneous resorption of intervertebral disc herniations. Spine (Phila Pa 1976). 2006; 31(11):1247-52. DOI: 10.1097/01.brs.0000217681.83524.4a. View

10.

McGirt M, Garces Ambrossi G, Datoo G, Sciubba D, Witham T, Wolinsky J . Recurrent disc herniation and long-term back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal. Neurosurgery. 2009; 64(2):338-44. DOI: 10.1227/01.NEU.0000337574.58662.E2. View

11.

Benson R, Tavares S, Robertson S, Sharp R, Marshall R . Conservatively treated massive prolapsed discs: a 7-year follow-up. Ann R Coll Surg Engl. 2009; 92(2):147-53. PMC: 3025225. DOI: 10.1308/003588410X12518836438840. View

12.

Fardon D, Williams A, Dohring E, Murtagh F, Gabriel Rothman S, Sze G . Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology, and the American Society of Neuroradiology. Spine (Phila Pa 1976). 2013; 39(24):E1448-65. DOI: 10.1097/BRS.0b013e3182a8866d. View

13.

Chiu C, Chuang T, Chang K, Wu C, Lin P, Hsu W . The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil. 2014; 29(2):184-95. DOI: 10.1177/0269215514540919. View

14.

Seo J, Roh Y, Kim Y, Ha K . Three-dimensional analysis of volumetric changes in herniated discs of the lumbar spine: does spontaneous resorption of herniated discs always occur?. Eur Spine J. 2014; 25(5):1393-1402. DOI: 10.1007/s00586-014-3587-1. View

15.

Saal J, Saal J . Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy. An outcome study. Spine (Phila Pa 1976). 1989; 14(4):431-7. DOI: 10.1097/00007632-198904000-00018. View

16.

Hong S, Kim D, Kim H, Kim S, Shin K, Kang S . Resorption of Massive Lumbar Disc Herniation on MRI Treated with Epidural Steroid Injection: A Retrospective Study of 28 Cases. Pain Physician. 2016; 19(6):381-8. View

17.

Baber Z, Erdek M . Failed back surgery syndrome: current perspectives. J Pain Res. 2016; 9:979-987. PMC: 5106227. DOI: 10.2147/JPR.S92776. View

18.

Gugliotta M, da Costa B, Dabis E, Theiler R, Juni P, Reichenbach S . Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. BMJ Open. 2016; 6(12):e012938. PMC: 5223716. DOI: 10.1136/bmjopen-2016-012938. View

19.

Guinto Jr F, Hashim H, Stumer M . CT demonstration of disk regression after conservative therapy. AJNR Am J Neuroradiol. 1984; 5(5):632-3. PMC: 8335144. View

20.

Komori H, Shinomiya K, Nakai O, Yamaura I, Takeda S, Furuya K . The natural history of herniated nucleus pulposus with radiculopathy. Spine (Phila Pa 1976). 1996; 21(2):225-9. DOI: 10.1097/00007632-199601150-00013. View