Spontaneous Regression of Herniated Lumbar Disc with New Disc Protrusion in the Adjacent Level

Spontaneous regression of herniated lumbar discs was reported occasionally. The mechanisms proposed for regression of disc herniation are still incomplete. This paper describes and discusses a case of spontaneous regression of herniated lumbar discs with a new disc protrusion in the adjacent level. A 41-year-old man was admitted with radiating pain and numbness in the left lower extremity with a left posterolateral disc extrusion at L5-S1 level. He was admitted to hospital with low back pain due to disc herniation caudally immigrating at L4-5 level three years ago. He refused the surgical intervention that was offered and was treated conservatively at that time. He had no neurological deficit and a history of spontaneous regression of the extruded lumbar disc; so, a conservative therapy, including bed rest, physical therapy, nonsteroidal anti-inflammatory drugs, and analgesics, was advised. In conclusion, herniated lumbar disc fragments may regress spontaneously. Reports are prone to advise conservative treatment for extruded or sequestrated lumbar disc herniations. However, these patients should be followed up closely; new herniation at adjacent/different level may occur. Furthermore, it is important to know which herniated disk should be removed and which should be treated conservatively, because disc herniation may cause serious complications as muscle weakness and cauda equine syndrome.

Download Full-text

Unilateral surgical approach for lumbar disc herniation with contralateral symptoms

Journal of Neurosurgery Spine ◽

10.3171/2012.4.spine11365 ◽

2012 ◽

Vol 17 (2) ◽

pp. 124-127 ◽

Cited By ~ 5

Author(s):

Taşkan Akdeniz ◽

Tuncay Kaner ◽

İbrahim Tutkan ◽

Ali Fahir Ozer

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Surgical Approach ◽

Lumbar Disc ◽

Radicular Pain ◽

Leg Pain ◽

Motor Deficits ◽

Disc Herniations ◽

Herniated Lumbar Disc ◽

Contralateral Symptoms

Object In most cases of lumbar disc herniation, the primary problem is usually limited to radicular pain due to nerve compression on the herniated side, which is generally limited to the side of operation. The aim of this study was to reevaluate the side of the surgical approach in a selected group of patients with leg pain and contralateral lumbar disc herniation. Methods Included in this study were a total of 5 patients with lumbar disc herniations who presented with contralateral symptoms and neurological signs. In all cases, patients underwent a microdiscectomy from the side ipsilateral to the herniated lumbar disc, the side contralateral to the motor deficits and leg pain. Results The symptoms and signs, to some extent, resolved during the immediate postoperative period. There were no postoperative complications. Conclusions The findings confirm that performing a laminotomy via the side of the herniation is sufficient for this group of patients.

Download Full-text

Does the Size or Location of Lumbar Disc Herniation Predict the Need for Operative Treatment?

Global Spine Journal ◽

10.1177/2192568220948519 ◽

2020 ◽

pp. 219256822094851

Author(s):

Srikanth N. Divi ◽

Heeren S. Makanji ◽

Christopher K. Kepler ◽

D. Greg Anderson ◽

Dhruv K. C. Goyal ◽

...

Keyword(s):

Operative Treatment ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Multiple Logistic Regression Analysis ◽

Relative Size ◽

Absolute Size ◽

Disc Protrusion ◽

Disc Herniations ◽

Magnetic Resonance Imaging Mri

Study Design: Retrospective cohort study. Objective: The goal of this study was to determine whether the absolute size (mm2), relative size (% canal compromise), or location of a single-level, lumbar disc herniation (LDH) on axial and sagittal cuts of magnetic resonance imaging (MRI) were predictive of eventual surgical intervention. Methods: MRIs of 89 patients were reviewed, and patients were split into groups based on type of management received (34 nonoperative vs 55 microdiscectomy). Radiographic characteristics—including size of disc herniation (mm2), size of spinal canal (mm2), location of herniation on axial (central, paracentral, foraminal) and sagittal (disc level, suprapedicle, pedicle, infrapedicle) planes, and type of herniation (bulge, protrusion, extrusion, sequestration)—were measured by 2 independent, orthopedic spine fellows and compared between groups via univariate and multivariate analyses. Results: The operative group showed a significantly higher percentage of canal compromise (39.5% vs 31.1%, P = .001) compared to the nonoperative group. Multiple logistic regression analysis showed higher odds of eventual operative intervention for a disc protrusion (odds ratio [OR] 6.30 [1.99, 19.86], P = .002) or disc extrusion (OR 11.5 [1.63, 81.2], P = .014) for Rater 1 and a higher odds of eventual surgical management for a paracentral location for both Rater 1 and Rater 2 (OR = 3.39 [1.25, 9.22], P = .017, and OR = 5.46 [1.77, 16.8], P = .003, respectively). Conclusions: Disc herniations in a paracentral location were more likely to undergo operative treatment than those more centrally located, on axial MRI views.

Download Full-text

Lumbar disc herniation associated with scoliosis in a 15-year-old girl: case report

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2002000200022 ◽

2002 ◽

Vol 60 (2A) ◽

pp. 295-298 ◽

Cited By ~ 10

Author(s):

Fernando Campos Gomes Pinto ◽

Arthur W. Poetscher ◽

Fausto Ricardo Erba Quinhones ◽

Mário Pena ◽

Mário Augusto Taricco

Keyword(s):

Disc Herniation ◽

Structural Changes ◽

Lumbar Disc ◽

Previous History ◽

Young Patients ◽

Rare Condition ◽

Intervertebral Disc Herniation ◽

Childhood And Adolescence ◽

Disc Herniations ◽

History Of

Intervertebral disc herniation is a rare condition in childhood and adolescence, although some cases have already been reported in the literature. We present the case of a 15 year-old-girl with low back pain and scoliosis. She had no previous history of trauma or collagen diseases. MRI showed L4-L5 and L5-S1 disc herniations and no further bone and structural changes. After two level discectomy, pain ceased and scoliosis improved, without further treatment. Based on her evolution and on what has already been reported in literature, we consider that scoliosis associated with disc herniation in young patients is most likely to be only an anthalgic position, not indicative of further structural changes.

Download Full-text

Characteristics and Factors Associated With Spontaneous Regression of Extruded Lumbar Disc Herniation: A Retrospective Analysis of 31 Cases

10.21203/rs.3.rs-200276/v1 ◽

2021 ◽

Author(s):

Qing-Guang Qin ◽

Jia Liu ◽

Li-Jing Zhao ◽

Shuai Yuan ◽

Fang Feng ◽

...

Keyword(s):

Linear Regression ◽

Multiple Linear Regression ◽

Acute Phase ◽

Lumbar Disc Herniation ◽

Spontaneous Regression ◽

Lumbar Disc ◽

Bed Rest ◽

Factors Associated ◽

Herniated Discs ◽

Rehabilitation Exercise

Abstract BackgroundLumbar disc herniation (LDH) is a common condition leading to high individual, social, and economic impacts. Reported rates of spontaneous resorption of LDH vary from 35% to 100%; however, it remains unclear how spontaneous absorption, rather than re-protrusion, can be maximized.Purpose The main objective of this study was to determine the characteristics and factors enabling for spontaneous regression of extruded LDH. DesignA retrospective single center case series. Patient sampleInpatients (n = 33) with LDH who experienced spontaneous regression between September 2015 and June 2020. Outcome measuresQuestionnaire responses and magnetic resonance imaging (MRI)-determined hernia regression.MethodsA questionnaire was distributed to patients to assess factors associated with hernia resorption, the volume of herniated intervertebral discs evaluated by MRI, and the absorption ratio calculated. Multiple linear regression was used to explore factors enabling spontaneous herniated disc regression. ResultsA total of 31 patients received a mean of 5.90 conservative treatments during hospitalization, and 1.91 during rehabilitation. Of patients, 90.32% underwent bed-rest during the acute phase of the disease, and 61.29% did so during rehabilitation. Rehabilitation exercise was undertaken by 93.55% of patients, with a mean of 2.42 exercise methods per patient. Waist lumbosacral orthosis devices were worn by 80.65% of patients. Multiple linear regression showed that bed-rest days in the acute phase (X1), herniation type (X2), time wearing lumbosacral orthosis (X3), onset-treatment duration (X4), and days of bed-rest days in rehabilitation (X5) had significant effects on the spontaneous regression ratio (y) of herniated discs (all P < 0.05). The optimal linear regression equation was y = 0.616 + 0.497X1 – 0.478X2 + 0.384X3 – 0.343X4 – 0.241X5. Conclusions Our findings support that patients with extruded or sequestered LDH should receive comprehensive treatment. Early treatment, early bed-rest, and lumbosacral orthosis protection promote the spontaneous regression of herniated discs; however, bed-rest during rehabilitation is a poor prognostic factor. Adherence to rehabilitation exercise will be beneficial to the recovery of patients with LDH.

Download Full-text

A Study of Lumbar Disc Herniation and Facet Joint Asymmetry

International Surgery ◽

10.9738/intsurg-d-16-00119.1 ◽

2019 ◽

Vol 103 (1-2) ◽

pp. 87-94

Author(s):

Qi Lai ◽

Yuan Liu ◽

Runsheng Guo ◽

Xin Lv ◽

Qiang Wang ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Facet Joint ◽

Lumbar Disc ◽

Patients Âgés ◽

Lower Lumbar Spine ◽

Significant Difference ◽

Facet Joint Degeneration ◽

Disc Herniations ◽

Lumbar Facet

Purpose: To investigate the association of facet joint asymmetry with lumbar disc herniation at the lower lumbar spine. Methods: A total of 90 patients (ages 18–40 years) with single-level disc herniation (L3–L4, L4–L5, or L5–S1) were included in the study. Facet asymmetry was defined as a difference of 10° in facet joint angles between right and left sides. Normal discs in the same segment of other individuals were used as a control. Patients had facet asymmetry measured for L3 to S1 through 3.0T magnetic resonance imaging, and information was collected, including age, sex, degenerative degree of lumbar facet joints, and the presence or absence of lumbar disc herniation and type. Results: At the L3 to L4 level, 2 cases had facet asymmetry in 8 patients with lumbar disc herniation, compared with 17 cases of facet asymmetry in 82 patients without disc herniation (P = 0.7776, r = 0.030). At the L4 to L5 level, there were 21 cases of facet asymmetry in 45 patients with lumbar disc herniation, compared with 5 cases of asymmetry in 45 patients without disc herniation (P = 0.00019, r = 0.392). At the L5 to S1 level, there were 25 cases of facet asymmetry in 37 patients with lumbar disc herniation, compared with 11 cases of facet asymmetry in 53 patients without disc herniation (P = 0.0000, r = 0.492). There were 23 cases of facet asymmetry in 28 disc herniations of side type compared with 2 cases of facet asymmetry in 9 herniations of center type (P = 0.0008, r = 0.364). There was no significant difference in the relationship between age, facet joint degeneration, and lumbar facet joint asymmetry (P > 0.05). Conclusion: Facet asymmetry is significantly associated with lumbar disc herniation at the L4 to L5 and the L5 to S1 levels, whereas there is an obvious association with the side type of lumbar disc herniation at the L5 to S1 level.

Download Full-text

Genotypic and Antimicrobial Characterisation ofPropionibacterium acnesIsolates from Surgically Excised Lumbar Disc Herniations

BioMed Research International ◽

10.1155/2013/530382 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 37

Author(s):

Jess Rollason ◽

Andrew McDowell ◽

Hanne B. Albert ◽

Emma Barnard ◽

Tony Worthington ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Herniated Disc ◽

Type Ii ◽

Type Ia ◽

Disc Herniations ◽

Typing Methods ◽

Human Infections ◽

Clinical Conditions

The anaerobic skin commensalPropionibacterium acnesis an underestimated cause of human infections and clinical conditions. Previous studies have suggested a role for the bacterium in lumbar disc herniation and infection. To further investigate this, five biopsy samples were surgically excised from each of 64 patients with lumbar disc herniation.P. acnesand other bacteria were detected by anaerobic culture, followed by biochemical and PCR-based identification. In total, 24/64 (38%) patients had evidence ofP. acnesin their excised herniated disc tissue. UsingrecAand mAb typing methods, 52% of the isolates were type II (50% of culture-positive patients), while type IA strains accounted for 28% of isolates (42% patients). Type III (11% isolates; 21% patients) and type IB strains (9% isolates; 17% patients) were detected less frequently. The MIC values for all isolates were lowest for amoxicillin, ciprofloxacin, erythromycin, rifampicin, tetracycline, and vancomycin (≤1mg/L). The MIC for fusidic acid was 1-2 mg/L. The MIC for trimethoprim and gentamicin was 2 to ≥4 mg/L. The demonstration that type II and III strains, which are not frequently recovered from skin, predominated within our isolate collection (63%) suggests that the role ofP. acnesin lumbar disc herniation should not be readily dismissed.

Download Full-text

The natural history of lumbar disc herniations assessed by a CT follow-up study

Proceedings of the XIV Symposium Neuroradiologicum ◽

10.1007/978-3-642-49329-4_27 ◽

1991 ◽

pp. 84-85 ◽

Cited By ~ 1

Author(s):

Kurt Pardatscher ◽

D. L. Fiore ◽

A. Barbiero

Keyword(s):

Natural History ◽

Lumbar Disc ◽

Follow Up Study ◽

Disc Herniations ◽

History Of

Download Full-text

Microsurgical Excision of Herniated Lumber Disc in Pediatric Population

Neuroscience and Neurological Surgery ◽

10.31579/2578-8868/008 ◽

2018 ◽

Vol 2 (3) ◽

pp. 01-05

Author(s):

Ahmed Zaher

Keyword(s):

Back Pain ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Pediatric Population ◽

Lumbar Disc ◽

Radicular Pain ◽

University Hospital ◽

Csf Leak ◽

Degree Relative ◽

History Of

Lumbar disc herniation is a relatively rare disorder among children and adolescent population compared to adults. The objectives of this work are to study the lumbar disc herniation in pediatric population and determine the surgical outcome of lumbar microdiscectomy in such population. Patients and methods: A series of 32 pediatric patients less than 18 years operated by microdiscectomy at Mansoura University hospital during the period from January 2005 to March 2015 were retrospectively analyzed. Clinical presentation, physical signs, predisposing factors, radiological investigations and operative findings were retrieved from medical records. Improvement of pain was assessed by visual analogue scale. Results: The study included 17 females (53.1%) and 15 males (46.9%) ranging in age from 10 to18 years (mean, 14.2 year). The patients were followed up for periods ranging from three to 115 months (mean, 55 months). All patients had radicular pain (100%) with additional back pain in twenty one patients (65.63%), twenty eight patients (87.5%) presented by sciatic pain while six patients (18.75%) showed femoral neuralgia. Straight leg raising test was positive in 90.62%. L4/5 was the commonest affected level in eighteen patients (56.25%) while twelve patients (37.5%) had disc herniation at L5-S1 level and only two patients had herniation at L3-4 disc level. Family history of lumbar disc herniation in first degree relative was positive in twenty one patients (65.63%). History of relevant trauma was documented in only twelve patients (37.5%). During surgery the disc was soft, rubbery and well hydrated in 90.6% of cases. Subligamentous disc herniation was observed in 81%, while 12.5% of patients had disc bulge with intact annulus and only 6.5% had extruded disc. All patients showed significant improvement of radicular pain at the time of discharge while back pain continued to improve during early postoperative follow up. Low back pain and radicular pain equally improved after three months despite instant postoperative improvement of radicular pain. Postoperative complications were rare and included one case of wound infection, one case of iatrogenic CSF leak and new neurological deficit in another case. Conclusion: Lumbar disc herniation in pediatric population differs from that of adults in many aspects. Microdiscectomy is safe and reliable procedure for management of pediatric lumbar disc herniation with good outcome and minimal morbidity

Download Full-text