Didry C, Lopez P, Baixas P, Simon L
Service d'Immuno-Rhumatologie, Centre Gui-de-Chauliac, Hôpital Saint-Eloi, Montpellier.
Presse Med. 1991 Feb 23;20(7):299-302.
The authors have studied the clinical and computed tomographic (CT) follow-up of 50 patients with nerve root symptoms and herniated nucleus pulposus (HNP) who received only a conservative medical treatment. The clinical follow-up showed that after 23 months 38 patients (76 percent) did not require surgery and 63 percent of these had good or very good results. Follow-up CT scans, performed in 20 patients, found spontaneous disappearance of NP in 10 cases and partial regression in 3 cases. Several mechanisms may explain this regression, including fragmentation and sequestration of the disc fragment, dehydration and shrinkage of the HNP and its reintegration into the annulus. On the other hand, HNP persisted in some patients who had become asymptomatic, and it was also found in an asymptomatic control subject. These data demonstrate that clinical and CT findings may be dissociated. Not all CT scan-documented HNPs require interventional therapy. Except in case of emergency, surgical treatment should be considered only after failure of conservative medical treatment and whenever clinical and CT data are concordant. CT and other imaging procedures, such as myelography and nuclear magnetic resonance, should only be used preoperatively in patients with appropriate clinical findings.
作者对50例仅有神经根症状且患有髓核突出（HNP）的患者进行了临床及计算机断层扫描（CT）随访，这些患者仅接受了保守药物治疗。临床随访显示，23个月后，38例患者（76%）无需手术，其中63%的患者取得了良好或非常好的效果。对20例患者进行的随访CT扫描发现，10例患者的髓核自发消失，3例部分消退。几种机制可解释这种消退，包括椎间盘碎片的碎裂和游离、HNP的脱水和收缩以及其重新整合入纤维环。另一方面，一些已无症状的患者中HNP依然存在，且在一名无症状对照者中也发现了HNP。这些数据表明临床和CT结果可能不一致。并非所有CT扫描记录的HNP都需要介入治疗。除非紧急情况，仅在保守药物治疗失败且临床和CT数据一致时才应考虑手术治疗。CT及其他成像检查，如脊髓造影和核磁共振，仅应在有适当临床发现的患者术前使用。
