Lumbar herniated disc: spontaneous regression

Abstract

Background: Low back pain is a frequent condition that results in substantial disability and causes admission of patients to neurosurgery clinics. To evaluate and present the therapeutic outcomes in lumbar disc hernia (LDH) patients treated by means of a conservative approach, consisting of bed rest and medical therapy.

Methods: This retrospective cohort was carried out in the neurosurgery departments of hospitals in Kahramanmaraş city and 23 patients diagnosed with LDH at the levels of L3-L4, L4-L5 or L5-S1 were enrolled.

Results: The average age was 38.4 ± 8.0 and the chief complaint was low back pain and sciatica radiating to one or both lower extremities. Conservative treatment was administered. Neurological examination findings, durations of treatment and intervals until symptomatic recovery were recorded. Laségue tests and neurosensory examination revealed that mild neurological deficits existed in 16 of our patients. Previously, 5 patients had received physiotherapy and 7 patients had been on medical treatment. The number of patients with LDH at the level of L3-L4, L4-L5, and L5-S1 were 1, 13, and 9, respectively. All patients reported that they had benefit from medical treatment and bed rest, and radiologic improvement was observed simultaneously on MRI scans. The average duration until symptomatic recovery and/or regression of LDH symptoms was 13.6 ± 5.4 months (range: 5-22).

Conclusions: It should be kept in mind that lumbar disc hernias could regress with medical treatment and rest without surgery, and there should be an awareness that these patients could recover radiologically. This condition must be taken into account during decision making for surgical intervention in LDH patients devoid of indications for emergent surgery.

Keywords: Conservative treatment; Diagnostic imaging; Intervertebral disc displacements; Low back pain; Lumbar vertebrae; Magnetic resonance imaging; Neurological examination; Outcome assessment.

Fig. 1. The sagittal MRI views of an LDH patient before (A) and after treatment (B). The patient was free of symptoms at 7^th month after treatment.

Fig. 2. The axial MRI views of the same patient before (A) and after treatment (B).

Fig. 3. The sagittal MRI views of another LDH patient before (A) and after treatment (B). The patient was free of symptoms at 16^th month after treatment.

Fig. 4. The axial MRI views of the same patient before (A) and after treatment (B).