Birbilis Theodossios A, Matis Georgios K, Theodoropoulou Efthimia N
Democritus University of Thrace, Medical School, Neurosurgical Department, University Hospital of Alexandroupolis, Greece.
Med Sci Monit. 2007 Oct;13(10):CS121-3.
The phenomenon of the spontaneous disappearance of herniated discs is well known.
The case of a 74-year-old male presenting with a large disc herniation at L5-S1, experiencing moderate sciatic pain, and having the straight-leg-raising test positive at 30 degrees is presented. The disc herniation was documented by computed tomography. He was treated conservatively with medication and physical therapy. One year later the patient was clinically reevaluated. He proved to be symptom-free and the follow-up computed tomography revealed spontaneous disappearance of the herniated disc fragment. The disc regression could have been due to dehydration, resorption as a result of an inflammatory reaction, or retraction into the intervertebral space.
This report discusses the three aforementioned possible explanations and underlines the need for limiting surgical treatment strictly to patients with neurological deficits, severe unremitting leg pain despite conservative measures, and repeated time loss from work.
椎间盘突出症自发消失的现象众所周知。
报告了一名74岁男性患者，其腰5-骶1节段存在巨大椎间盘突出，伴有中度坐骨神经痛，直腿抬高试验在30度时呈阳性。通过计算机断层扫描记录了椎间盘突出情况。他接受了药物和物理治疗的保守治疗。一年后对患者进行了临床重新评估。结果显示他无症状，随访计算机断层扫描显示突出的椎间盘碎片自发消失。椎间盘的退缩可能是由于脱水、炎症反应导致的吸收或回缩至椎间隙。
本报告讨论了上述三种可能的解释，并强调了严格将手术治疗限制于有神经功能缺损、尽管采取保守措施仍有严重且持续的腿痛以及多次误工的患者的必要性。
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