Spontaneous and rapid resolution of a massive lumbar disc herniation

Background: Most lumbar disc herniations can be successfully treated conservatively. However, massive lumbar disc herniations are often treated surgically to avoid permanent cauda equina syndromes/neurological deficits and potential litigation. Nevertheless, here, we present a 51-year-old female who refused lumbar surgery due to coronavirus disease 2019 (COVID-19) and sustained a full spontaneous recovery without surgical intervention. Case Description: A 51-year-old female presented with a massive lumbar disc herniation at the L5S1 level. Despite refusing surgery for fear of getting COVID-19, she spontaneously neurologically improved without any residual neurological or radiographic sequelae. Conclusion: Although the vast majority of patients with massive lumbar disc herniations are managed surgically, there are rare instances in which nonoperative management may be successful.

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Caudal Lumbar Disc Herniations Are More Likely to Require Surgery for Symptom Resolution

Global Spine Journal ◽

10.1177/2192568220905849 ◽

2020 ◽

pp. 219256822090584

Author(s):

Anmol Gupta ◽

Shivam Upadhyaya ◽

Caleb M. Yeung ◽

Peter J. Ostergaard ◽

Harold A. Fogel ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Nonoperative Management ◽

Lumbar Disc ◽

Strong Association ◽

Cauda Equina ◽

Radicular Pain ◽

Motor Deficits ◽

Disc Herniations ◽

The Impact

Study Design: Retrospective study. Objectives: We examined the impact that location of a lumbar disc herniation has on the likelihood that a patient will require surgery after at least 6 weeks of nonoperative management. Methods: Using ICD-10 codes M51.26 and M51.27, we identified patients at a single academic institution from 2015 to 2016 who received a diagnosis of primary lumbar radicular pain, had magnetic resonance imaging confirming a lumbar disc herniation, and underwent at least 6 weeks of nonoperative management. Patients experiencing symptoms suggesting cauda equina syndrome or progressive motor deficits were excluded. Results: Five hundred patients met inclusion/exclusion criteria. Twenty-nine (5.8%) had L3-L4 herniations, 245 (49.0%) had L4-L5 herniations, and 226 (45.2%) had L5-S1 herniations. Overall, 451 (90.2%) patients did not undergo surgery within 1 year of diagnosis. Nonsurgical patients had an average herniation size occupying 31.2% of the canal, compared with 31.5% in patients who underwent surgery. While herniation size, age, sex, and race failed to demonstrate a statistical association with the likelihood for surgery, location of disc herniation demonstrated a strong association. L3-L4 and L4-L5 herniations had odds ratios of 0.19 and 0.45, respectively, relative to L5-S1 herniations ( P = .0047). Patients were more than twice as likely to require a surgery on an L5-S1 herniation in comparison with an L4-L5 herniation ( P < .05). L3-L4 herniations rarely required surgery. Conclusions: Patients with caudal lumbar disc herniations were more likely to require surgery after at least 6 weeks of conservative management than those with disc herniations in the mid-lumbar spine.

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Herniated discs: when is surgery necessary?

EFORT Open Reviews ◽

10.1302/2058-5241.6.210020 ◽

2021 ◽

Vol 6 (6) ◽

pp. 526-530

Author(s):

Wai Weng Yoon ◽

Jonathan Koch

Keyword(s):

Disc Herniation ◽

Controlled Trial ◽

Lumbar Disc ◽

Cauda Equina ◽

Neurological Symptoms ◽

Neurological Deficits ◽

Cervical Disc ◽

Indications For Surgery ◽

Disc Herniations ◽

Thoracic Disc

In all levels of disc herniations the absolute surgical indications include deteriorating neurological deficits with myelopathy or cauda equina syndrome. However, this review summarized the relative indications for surgery in each level. In cervical disc herniation (CDH), the indications for surgery consist of six months of persisting symptoms, not responding to conservative treatment. However, high-quality studies are lacking, and a randomized controlled trial is now underway to clarify the indications. In thoracic disc herniation (TDH), the indications for surgery comprise failure of conservative measures and/or worsening neurological symptoms. Moreover, giant calcified thoracic disc herniations or myelopathy signs on magnetic resonance imaging, even in the absence of neurological symptoms, may benefit from surgical treatment as a preventive measure. In lumbar disc herniation (LDH), the indications for surgery include imaging confirmation of LDH, consistent with clinical findings, and failure to improve after six weeks of conservative care. Cite this article: EFORT Open Rev 2021;6:526-530. DOI: 10.1302/2058-5241.6.210020

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The Effectiveness of Moxibustion for Treating of Lumbar Disc Herniation(LDH): A Protocol for Systematic Review and Meta-ananlysis

10.21203/rs.3.rs-60111/v1 ◽

2020 ◽

Author(s):

Zenan Wu ◽

Jun Xiong ◽

Guixing Xu ◽

Zhengyun Zuo ◽

Yi Yang ◽

...

Keyword(s):

Systematic Review ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Clinical Symptoms ◽

Lumbar Disc ◽

Cauda Equina ◽

The Body ◽

Lumbar Pain ◽

Cochrane Library ◽

Disc Herniations

Abstract Background: Lumbar disc herniation (LDH) refers to lumbar disc degeneration or external pressure, resulting in annulus fibrosus rupture, nucleus pulposus protrusion or bulging, compression of nerve roots, cauda equina nerve, and then some clinical symptoms of a clinical syndrome, clinical symptoms are often manifested as unilateral or bilateral lumbar pain, leg numbness. L3/L4,L4/L5, and L5/S1 intervertebral disc herniations are common in the lesion sites of lumbar disc herniations, and the incidence rate is as high as 90%. Typical manifestations are tenderness at the corresponding surface of the body. This disease is a common and frequently-occurring disease in the department of rehabilitation and acupuncture of the hospital, and is a common cause of lumbago and leg pain. At present, the common external treatment for LDH includes many methods,mostly acupuncture and moxibustionMethods: We're going to use systematic electronic search, including PubMed,MEDLINE, Cochrane library, SinoMed,CNKI,WF,VIPand checked references of retrieved articles. Randomized controlled trials (RCTs) on acupotomy treatment in LDH patients will be searched for independently by 2 reviewers in the databases from their inception to August 2020. We will combine data from clinically homogenous studies in a fixed effect meta-analysis using RevManV.5.3.5, and the evidence level will be assessed by using the method for Grading of Recommendations Assessment, Development, and Evaluation (GRADE).Discussion: The results of this review will provide reliable evidence for effectiveness and safety of moxibustion for treating LDH.Systematic review registration: CRD42020187626

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Outcome of Delayed Decompression Surgery for Cauda Equina Syndrome secondary to Lumbar Disc Herniation: A Case Report

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v18i2.88 ◽

2020 ◽

Vol 18 (2) ◽

Author(s):

Lim SM ◽

Johari J ◽

Yusof MI

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Cauda Equina Syndrome ◽

Lumbar Disc ◽

Cauda Equina ◽

Bowel Dysfunction ◽

Decompression Surgery ◽

Motor Weakness ◽

Post Surgery ◽

Maximum Improvement

Cauda equina syndrome (CES) is a constellation of symptoms which consist of low back pain, sciatica, saddlearea paraesthesia, urinary or faecal incontinence, with or without motor weakness, and sensory deficit. Surgical decompression is indicated as soon as possible, as decompression within 48 hours from onset allows maximum improvement of symptoms. Recovery usually occurs months or years postoperatively. We report a case of a patient with cauda equina syndrome secondary to massive lumbar disc herniation who had undergone urgent decompression one week after onset of urinary and bowel dysfunction. The clinical outcome post surgery was also discussed.

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Analysis of clinical and neurological outcomes in patients with cauda equina syndrome caused by acute lumbar disc herniation: a retrospective-prospective study

Oncotarget ◽

10.18632/oncotarget.20453 ◽

2017 ◽

Vol 8 (48) ◽

pp. 84204-84209

Author(s):

Si-Dong Yang ◽

Feng Zhang ◽

Wen-Yuan Ding

Keyword(s):

Prospective Study ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Cauda Equina Syndrome ◽

Lumbar Disc ◽

Cauda Equina ◽

Neurological Outcomes

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Meningeal syndrome and cauda equina syndrome following surgery for L5-S1 lumbar disc herniation: evolution at 2 years

Revista Española de Cirugía Ortopédica y Traumatología (English Edition) ◽

10.1016/s1988-8856(09)70178-6 ◽

2009 ◽

Vol 53 (4) ◽

pp. 278-280

Author(s):

A. Molina Ros ◽

A. Matamalas Adrover ◽

A. Garcia de Frutos

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Cauda Equina Syndrome ◽

Lumbar Disc ◽

Cauda Equina

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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.

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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.

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