Spontaneous Regression of Lumbar Herniated Disc

Abstract

Intervertebral disc herniation of the lumbar spine is a common disease presenting with low back pain and involving nerve root radiculopathy. Some neurological symptoms in the majority of patients frequently improve after a period of conservative treatment. This has been regarded as the result of a decrease of pressure exerted from the herniated disc on neighboring neurostructures and a gradual regression of inflammation. Recently, with advances in magnetic resonance imaging, many reports have demonstrated that the herniated disc has the potential for spontaneous regression. Regression coincided with the improvement of associated symptoms. However, the exact regression mechanism remains unclear. Here, we present 2 cases of lumbar intervertebral disc herniation with spontaneous regression. We review the literature and discuss the possible mechanisms, the precipitating factors of spontaneous disc regression and the proper timing of surgical intervention.

The Results of Percutaneous Intradiscal High-Pressure Injection of Saline in Patients with Extruded Lumbar Herniated Disc: Comparison with Microendoscopic Discectomy

“…Although the natural history of lumbar herniations is characterized by the disappearance of clinical symptoms in up to 50% of patients, with shrinkage of the disc herniation within 8–9 months [6], most patients cannot tolerate their symptoms for such a long period of time. In other studies, the occurrence of spontaneous regression of herniated lumbar discs was around 35–63% on average, during a period of 6 months to 1 year [7,8]. Lumbar discectomy is the standard treatment for leg pain caused by radiculopathy from lumbar intervertebral disc extrusion [9].…”

A Recurrent Huge Sequestered Lumbar Disc Treated with Non-Operative Measures

“…The natural course of LDH is benign in majority cases as herniated disc regresses spontaneously 2,11) . Three mechanisms are known to play a role in regression of herniated disc; dehydration of herniated disc, retraction of herniated disc and inflammatory reaction and neovasculization 6,9,15,19,21,22) . Paradoxically, in the cases of large herniated disc, it shows obvious decrease in herniated disc size 15,19,22) .…”

Spontaneous Regression of a Large Lumbar Disc Extrusion

“…Conservative treatment should be considered when cauda equina syndrome or progressive motor weakness are absent in the acute stage of the lumbar herniated disc. Surgical intervention should be considered in cases with neurological deficits or intractable low back and leg pain despite the initial conservative treatment 4,18) . …”