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

Abstract

Purpose: 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 two groups: operated (within the first month after diagnosis) and nonoperated. Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores at baseline (V1) and 1st (V2), 3rd (V3), 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 three groups: nonregression (n=6), partial regression (n=22), and complete resolution (n=27); patients were analyzed in four 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 and at V4 in partial regression and complete resolution groups. VAS and ODI score improvements at V2 and V3 were significantly higher in the operated group than in other groups. At V4, no significant difference remained between the operated group and partial regression and complete resolution groups regarding VAS and ODI scores. Conclusions: Spontaneous regression was observed in the 6th month 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 found to have no difference with spontaneous regression patients at the 6th month.

Effect of Nonsurgical Spinal Decompression on Intensity of Pain and Herniated Disc Volume in Subacute Lumbar Herniated Disc

“…Subacute L-HIVD and the associated pain often recover spontaneously [31][32][33][34][35], while nerve edema and brous tissue around the L-HIVD decrease over weeks or months.…”

“…Although the principle of reabsorption of the L-HIVD is unclear, the nucleus pulposus of the disc is exposed to the vascular tissue in the epidural space, and the chemokines secreted from macrophages play an important role in phagocytosis. Shrinkage of L-HIVD is caused by decreased nutrient supply [ 34 , 37 ]. It is expected that this natural course of L-HIVD was actively conducted in the acute/subacute phase, and our study was performed on subacute L-HIVD patients (4 weeks–3 months).…”

“…It is expected that this natural course of L-HIVD was actively conducted in the acute/subacute phase, and our study was performed on subacute L-HIVD patients (4 weeks–3 months). Therefore, both groups would be expected to recover spontaneously [ 34 , 35 , 38 ], and the difference in pain relief may be minimal.…”

“…In another study, 66 (67.3%) of a total of 98 patients did not undergo surgery, even in sequestered L-HIVD. Following the MRI scan conducted in 80 patients 6 months later, 6 (10.9%) patients were included in the nonregression, 22 (40%) in the partial regression, and 27 (49.1%) in the complete resolution groups [ 34 ]. In our study, group D showed an approximately 30% reduction in HI at three months.…”

Rehabilitation of patients after lumbar microdiscectomy

“…Большинство грыж возникают на уровне L IV-V и L V -S I , поэтому основную часть случаев (90-95%) составляют радикулопатии L V и S I [3][4][5][6]. Большинство случаев поясничной дискогенной радикулопатии имеют благоприятное течение, что связано с естественным уменьшением размеров грыжи диска, которое возможно в течение нескольких месяцев, а также с регрессом вызванного грыжей воспаления, возникающим в течение нескольких недель и опережающим уменьшение размеров грыжи [9][10][11][12]. Однако у части пациентов боль и нетрудоспособность сохраняются в течение 1-2 мес на фоне консервативного лечения, поэтому обсуждается вопрос хирургического лечения, которое может привести к быстрому регрессу боли и улучшению функционального состояния пациентов [8,13].…”