Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 2  |  Issue : 1  |  Page : 26-28

Spontaneously disappearing large herniated lumbar disc fragment


1 Department of Radiology, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
2 Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India

Date of Web Publication10-Jun-2014

Correspondence Address:
Amit Agrawal
Professor of Neurosurgery, Department of Neurosurgery, Narayna Medical College Hospital, Chinthareddypalem, Nellore 524 003, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-2585.134208

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  Abstract 

There are reports of spontaneous regression of large extruded disc; however, the exact underlying mechanism and management of such cases remains controversial. We report a 40-year-old female who opted for conservative management for a large extruded lumbar disc. Follow-up magnetic resonance imaging (MRI) showed complete disappearance of the disc fragment; however, there were degenerative changes in the upper and lower adjacent margins of the vertebral body. Spine surgeons should be aware of spontaneous regression of the disc phenomenon as a patient with a large extruded disc who opted for the conservative management initially can have persistence pain, but there may not be an underlying protruded disc.

Keywords: Disappearing disc, herniation, lumbar disc, regression disc, spontaneous regression


How to cite this article:
Reddy UV, Agrawal A, Hegde KV, Suneetha P, Rao MG. Spontaneously disappearing large herniated lumbar disc fragment. J Orthop Allied Sci 2014;2:26-8

How to cite this URL:
Reddy UV, Agrawal A, Hegde KV, Suneetha P, Rao MG. Spontaneously disappearing large herniated lumbar disc fragment. J Orthop Allied Sci [serial online] 2014 [cited 2019 Nov 20];2:26-8. Available from: http://www.joas.in/text.asp?2014/2/1/26/134208


  Introduction Top


Herniated lumbar disc is one of the common causes of low back pain and smaller disc herniations tend to regress over a period of time; and thus, the pain is known to improve with conservative management. [1],[2],[3],[4],[5] There are reports of spontaneous regression of large extruded disc; however, the exact underlying mechanism and management of such cases remains controversial. [4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19]


  Case Report Top


A 40-year-old female presented with low back pain of 2 year duration. The pain was radiating to lower limbs more to the left side. There was no history of motor or sensory deficits. There was no history of bowel or bladder dysfunction. She was investigated for the similar problem with an MRI 6 months back and it showed a large disc protrusion [Figure 1]. However, she opted for conservative management. On examination, there were no focal motor or sensory deficits. Deep tendon reflexes were normal except bilateral sluggish ankle jerks. Planters were flexor. As the patient was complaining in the severity of the pain with numbness and a repeat magnetic resonance imaging (MRI) was performed. Follow-up MRI showed complete disappearance of the disc fragment; however, there were degenerative changes in the upper and lower adjacent margins of the vertebral body [Figure 2].
Figure 1: Magnetic resonance imaging T1-weighted and T2W sagittal images and fl uid-attenuated inversion recovery axial image showing a large extruded disc at L4– 5 level more on the right side with compression of the thecal sac

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Figure 2: Follow-up MRI T2W sagittal images at 6 months showing complete disappearance of the extruded disc with Modic changes in the lower end plate of L4 and upper end plate of L5 vertebral body

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  Discussion Top


Spontaneous regression of herniated disc material was first documented in 1984; [20],[21] and since then, many authors have reported reduction in the size of herniated disc material on follow-up images with conservative treatment. [4],[11],[12],[13],[21],[22],[23],[24] The exact timing for spontaneous regression of the protruded disc material is not known; however, it ranges from few weeks to months. [5],[10],[11],[17],[21],[22],[25],[26],[27] The fastest regression of the fragmented disc material was reported in 2 months. [8] Many hypotheses have been proposed to explain the regression of the disc material including retraction of the herniated disc material, dehydration of herniated disc material, and inflammatory reaction and neovascularization. [10],[18],[20],[28],[29] Inflammatory reaction and neovascularization is the widely accepted hypothesis where the extruded disc material is recognized as a foreign body inducing an inflammatory reaction and followed by removal of the disc material. [10],[20],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37]


  Conclusion Top


Present case illustrates that a conservative approach can be adopted for a large extruded lumbar disc as it can resolve in a selective group of patients. [24],[38],[39] Spine surgeons should be aware of spontaneous regression of the disc phenomenon as a patient with a large extruded disc who opted for the conservative management initially can have persistence pain, but there may not be an underlying protruded disc. It is important to perform a repeat imaging of the spine to assess the degree and severity of the disc protrusion before making a plan for surgery or any further conservative management.

 
  References Top

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