Clinical and Radiological Follow-Up Results of Patients with Sequestered Lumbar Disc Herniation: A Prospective Cohort Study

Abstract

Purpose: The aim of the study was to assess radiological changes and clinical outcomes of patients with sequestered lumbar disc herniation (LDH) and evaluate the relationship between them.

Methods: Patients diagnosed with sequestered LDH were followed up in 2 groups: operated (within the 1st month after diagnosis) and nonoperated. Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores at baseline (V1) and 1st (V2), 3rd (V3), and 6th (V4) month visits were used for clinical evaluation. Radiological evaluation was performed by measuring the sequestered LDH level and herniation volume using magnetic resonance imaging (MRI) at V1 and V4. After the second MRI, patients in the nonoperated group were divided into 3 groups: nonregression (n = 6), partial regression (n = 22), and complete resolution (n = 27); patients were analyzed in 4 groups including the ones in the operated (n = 25) group.

Results: Significant improvements were observed in VAS and ODI scores at V2 and V3 in all groups (p = 0.000) and at V4 in partial regression and complete resolution groups (p = 0.000). VAS and ODI score improvements at V2 and V3 were significantly higher in the operated group than in other groups (p = 0.000). At V4, there were no significant differences in VAS and ODI scores (p > 0.05) between the operated group and partial regression and complete resolution groups.

Conclusion: Spontaneous regression was observed in the 6th month post-MRI in most of the nonoperated sequestered LDH patients with conservative treatment. Improvements in pain and disability scores were higher among the operated patients at the early stage, whereas they were not significantly different compared to patients with spontaneous regression at the 6th month.

Keywords: Lumbar disc herniation; Magnetic resonance imaging; Neurology; Pain; Radiology; Rehabilitation; Sequestered lumbar disc herniation; Spontaneous regression.

Fig. 1

Flow diagram of the study. MRI, magnetic resonance imaging.

Fig. 2

View of caudal migrated sequestered disc hernia compressing the right lateral L5 root at the L4–L5 level on sagittal (a) and axial (b) sections in the MRI performed at V1 (baseline). View of complete resolution at the L4–L5 level on sagittal (c) and axial (d) sections in the MRI performed at V4 (follow-up). MRI, magnetic resonance imaging.

Fig. 3

Comparison of changes in the VAS scores over time between the groups. Lower values correspond to clinical improvement. Visits: baseline (V1); 1st month (V2); 3rd month (V3); 6th month (V4). * Mean. ** Significant improvements in the VAS scores within the groups continued in all follow-ups (V2, V3, and V4) of partial regression and complete resolution groups (p = 0.000). *** The operated group had significantly lower VAS scores at V2 and V3 than the other groups (p = 0.000). **** At V4, the VAS scores in the operated group were no different from those of partial regression and complete resolution groups (p = 0.812). VAS, visual analog scale.

Fig. 4

Comparison of changes in the ODI scores over time between the groups. Lower values correspond to clinical improvement. Visits: baseline (V1); 1st month (V2); 3rd month (V3); 6th month (V4). * Mean. ** Significant improvements in the ODI scores within the groups continued in all follow-ups (V2, V3, and V4) of partial regression and complete resolution groups (p < 0.05). *** The operated group had significantly lower ODI scores at V2 and V3 than the other groups (p = 0.000). **** At V4, the VAS scores in the operated group were no different from those of partial regression and complete resolution groups (p = 0.800). ODI, Oswestry Disability Index; VAS, visual analog scale.