Regresión espontánea de hernias discales intervertebrales. A propósito de una serie de 37 casos

Abstract

Disc herniation can regress, or even disappear, in a number of patients, rendering the radiological findings not to be taken as the only surgical indication criterium. We consider that the best treatment is the one relying on a good doctor-patient relationship, suspended in a balance between conservative and surgical treatment. According to clinical data, the first one (conservative) should not exceed the estimated time beyond which the surgical result would be unsatisfactory. The second one (operative), excepting "need-to operate" situations (such as cauda equina compression, progressive or serious motor déficit, or unbearable pain), should be prudently supedited to MRI regresión control, in particular in patients in which a clinical improvement is observed. Thus, the disc herniation conservative healing, both clinical as radiological, do exist, being a concept to widespread among clinicians and patients also.

A Rare Case of Near Complete Regression of a Large Cervical Disc Herniation without Any Intervention Demonstrated on MRI

“…Regression of lumbar disc herniation without any surgical treatment is well known and many cases are reported in the literature [1, 3, 5]. Regression of cervical disc herniation is occasionally reported [1, 3–6] and regression of thoracic disc herniation is rarely reported in the literature [2].…”

“…Regression of cervical disc herniation is occasionally reported [1, 3–6] and regression of thoracic disc herniation is rarely reported in the literature [2]. Most of the reported cases of regression of cervical disc herniation were diagnosed using computed tomography and approximately 47 cases only were diagnosed using MRI [1, 3–6]. …”

“…Morbidity and mortality are relatively less in this surgical procedure and surgery could result in more complete and speedier clinical improvements [1]. The finding of spontaneous regression of cervical disc herniation, however, suggests that many of these herniated cervical discs can be managed without any surgical intervention [1, 3–6]. Few authors have suggested that location, level, and type of intervertebral disc herniation in the cervical region determine its likelihood to regress or resolve spontaneously.…”

“…The process of disc dehydration and resorption of hematoma after the annular rupture contribute to the reduced size or regression of the herniated disc as seen in MRI images [1, 3–6]. Autolysis and loss of hydrophilic capacity of proteoglycan chains of the herniated disc fragments were demonstrated to cause regression of herniated discs in rabbits [1].…”

“…Autolysis and loss of hydrophilic capacity of proteoglycan chains of the herniated disc fragments were demonstrated to cause regression of herniated discs in rabbits [1]. Some authors suggest that the immune system mounts a reaction against the herniated disc material considering it as a foreign body, causing inflammatory changes, new vessel formation, and phagocytosis, consequently leading to regression of the herniated disc [1, 3–6]. …”