Spontaneous regression of extruded lumbar disc herniation: Correlation with clinical outcome

Abstract

Objective: To evaluate the natural history of lumbar extruded disc with conservative treatment on MRI and to assess relation between the radiologic changes and clinical outcome.
 Methods: This prospective observational study was conducted at University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital between May 2015-June 2018. It included consecutive patients who were diagnosed as having lumbar symptomatic extruded disc as shown in MRI. After an average period of 17.0±7.2 months, repeat MRI was taken in 40 patients who received only conservative care during follow-up. Changes in the volume of herniated disc was measured. The patients were assigned into 3 groups as follow: (1) non-regression, (2) partial-regression, and (3) complete resolution. Numeric Rating Scale (NRS) pain score, the Oswestry Low Back Pain Disability Index (ODI) and muscle weakness were evaluated.
 Results: Based on disc volume of the T2-weighted MR images; four patients (10%) did not show any regression, six patients (15%) had a partial regression, and 30 patients (75%) had a complete resolution. Patients with complete resolution showed a significant improvement in the NRS pain score and the ODI score (p<0,001) over time. In patients with partial regression, only the ODI score improved significantly (p=0,043). Non-regression group did not show any improvement in any clinical outcome measure (p>0,05). Changes in the NRS scores over time were significantly higher in complete resolution group compared to non-regression group (p=0.016).
 Conclusion: The majority of the patients with extruded lumbar disc herniation might have reduction in size of herniated disc in the long run along with improvement in symptoms and function with conservative care.
 doi: https://doi.org/10.12669/pjms.35.4.346
 How to cite this:Kesikburun B, Eksioglu E, Turan A, Adiguzel E, Kesikburun S, Cakci A. Spontaneous regression of extruded lumbar disc herniation: Correlation with clinical outcome. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.346
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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

“…The sequestered LDH level and sequestered hernia (fragment) volume of the patients were determined. The hernia volume (mm 3 ) was calculated by measuring the area (mm 2 ) in each axial image and multiplying this value by the scanning thickness (4 mm) plus intraslice clearance (1 mm) [7]. The patients were divided into 3 groups depending on the change in the volume of the sequestered disc hernia in the sagittal and axial views: (1) nonregression: no change in disk volume; (2) partial regression: >25% herniation size reduction; and (3) complete resolution: herniated disc volume is absent (Fig.…”

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Clinical Significance of Protrusion Edge Enhancement Using Contrast-Enhanced Magnetic Resonance Imaging in The Conservative Treatment of Giant Lumbar Disc Herniation: A Prospective Observational Study

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