Spontaneous regression of herniated cervical disc: A case report and literature review

Abstract

Background: We have reviewed 75 cases plus our own single instance of spontaneous regression of herniated cervical discs.

Methods: We searched PubMed and EMBASE databases (until September 2020) utilizing the following keywords; "spontaneous regression," "herniated cervical disc," and "Magnetic Resonance Imaging (MRI) studies."

Results: In the literature, we found 75 cases of herniated cervical discs which spontaneously regressed; to this, we added our case. Patients averaged 40.95 years of age. Discs were paracentral or foraminal in 84% of the cases, with most occurring at the C5-C6 (51%) and C6-C7 (36%) levels. Symptoms included neck pain/radiculopathy (91%) or myelopathy (9%). The average interval between initial presentation and spontaneous regression of herniated discs on MRI was 9.15 months. Interestingly, on MRI, extruded/sequestrated discs were more likely to undergo spontaneous regression versus protruding discs.

Conclusion: Successive MRI studies documented the spontaneous regression of herniated cervical discs over an average of 9.15 months. Although this may prompt greater consideration for conservative treatment in younger patients without neurologic deficits, those with deficits should be considered for surgery.

Keywords: Extruded; Foraminal; Herniated cervical disc; Paracentral; Spontaneous regression.

Figure 1:

(a) MRI cervical spine, sagittal view, suggestive of a posterior disc extrusion at the C6-C7 level indenting the cervical spinal cord. (b) Follow-up MRI cervical spine, sagittal view, 3 months later revealed significant spontaneous regression of the C6-C7 intervertebral disc extrusion.

Figure 2:

(a) MRI cervical spine, axial view, suggestive of a posterior disc extrusion at the C6-C7 level in the right paracentral location indenting the cervical spinal cord and the exiting right C7 root. (b) Follow-up MRI cervical spine, axial view, 3 months later revealed significant spontaneous regression of the C6-C7 intervertebral disc extrusion.

Figure 3:

Pie chart showing that the male-to-female ratio was approximately 1:1.

Figure 4:

Pie chart depicting that 91% of the cases of spontaneous regression of herniated cervical disc had symptoms of neck pain, radiculopathy, and/or upper limb amyotrophy. Only 9% of the cases presented with early symptoms of myelopathy.

Figure 5:

Pie chart depicting that the position of the herniated disc was paracentral or foraminal in 84% of the cases.

Figure 6:

Pie chart showing that the most common involved levels where spontaneous regression of herniated cervical disc was observed were C5-C6 followed by C6-C7.