Nozawa Satoshi, Nozawa Asae, Kojima Hisashi, Shimizu Katsuji
Department of Orthopedic Surgery, Gifu Municipal Hospital, Gifu, Japan.
Orthopedics. 2009 Nov;32(11):852. doi: 10.3928/01477447-20090922-21.
Although spontaneous regression of disk herniation is a well-known phenomenon, the time taken for the condition to resolve has not been detailed in previous studies. This article describes a case of vanishing lumbar disk herniation in a 33-year-old man. The patient experienced sudden severe lumbar pain while lifting a 240-kg weight while attempting a Donkey Calf Raise during muscle training. The pain persisted despite the use of a lumbar corset and nonsteroidal anti-inflammatory drugs. Twelve days after onset, sensory disturbance appeared in the right L5 dermatome, and a manual muscle test of the right anterior tibial muscle revealed level 3. The pain gradually spread over the right lower extremity and the indistinct lumbago changed to localized back pain at the L4/5 vertebral level. Magnetic resonance imaging (MRI) of the lumbar spine 12 days after onset revealed a large disk herniation at L4/5. T2-weighted images demonstrated the herniated disk with a sequestrated disk fragment, which compressed the right L5 nerve root. Over the following month, his pain gradually diminished and he was able to resume his muscle-building program. Follow-up MRI 3 months after the lumbar injury showed complete disappearance of the extruded disk material. This is the first reported case of disk herniation that disappeared within only 3 months, as previous reports have reported that a minimum 30-week period was needed. Clinical awareness of the possibility that disk herniation may resolve within a relatively short time may aid both correct informed consent and treatment.
尽管椎间盘突出症的自然消退是一种众所周知的现象，但此前的研究尚未详细说明病情缓解所需的时间。本文描述了一名33岁男性腰椎间盘突出症消失的病例。该患者在肌肉训练中尝试驴式小腿抬高动作时，举起240公斤重物时突然出现严重腰痛。尽管使用了腰部束腹带和非甾体类抗炎药，疼痛仍持续。发病12天后，右侧L5皮节出现感觉障碍，右侧胫骨前肌的徒手肌力测试显示为3级。疼痛逐渐蔓延至右下肢，起初不明确的腰痛转变为L4/5椎体水平的局限性背痛。发病12天后的腰椎磁共振成像（MRI）显示L4/5水平有一个大的椎间盘突出。T2加权图像显示突出的椎间盘伴有一个游离的椎间盘碎片，压迫右侧L5神经根。在接下来的一个月里，他的疼痛逐渐减轻，能够恢复他的肌肉锻炼计划。腰椎损伤3个月后的随访MRI显示突出的椎间盘物质完全消失。这是首例报告的仅在3个月内椎间盘突出就消失的病例，因为此前的报告称至少需要30周的时间。临床上认识到椎间盘突出症可能在相对较短时间内消退的可能性，可能有助于正确的知情同意和治疗。
