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[Spontaneous regression from intervertebral disc herniation. Propos of a series of 37 cases].

作者信息

Martínez-Quiñones J V, Aso-Escario J, Consolini F, Arregui-Calvo R

机构信息

Hospital MAZ, Zaragoza.

出版信息

Neurocirugia (Astur). 2010 Apr;21(2):108-17.


DOI:
PMID:20442973
Abstract

INTRODUCTION: The intervertebral disc disease (IDD) is one of the most common muscle-skeletal disorders, causing both high work disability and elevated healthcare costs. There are two specific origins of disk disease that should be kept in mind: degenerative (DDD) and traumatic (TDD). Concerning the TDD, nowadays it has not been determined which patients could gradually improve and which ones will require surgery. Some studies indicate that about 85% of lumbar and 90% cervical acute disc herniation will get better in an average of 6 weeks. MATERIALS AND METHODS: We conducted an observational, prospective study, over a group of 858 patients, with the following inclusion criteria: 1. MRI imaging indicating TDD, 2. No signs or symptoms requiring urgent surgical treatment (cauda equina syndrome, progressive or serious motor deficit or unbearable pain) and 3. Development of progressively spontaneous symptoms remission. All of the patients included in our study were treated in our Department of Neurosurgery from 2006 to 2007. Patients were tested for disc herniation regression with a second MRI study. RESULTS: A spontaneous regression of their hernia was appreciated as follow: 33 cases of lumbar hernia (29 male, 4 female), 3 cervical hernia (1 male, 2 female) and 1 dorsal hernia (male). DISCUSSION: Research about other reported series was done, and the different factors that could take place in disc spontaneous regression were analyzed: a) lodgement of the herniated disc back into the intervertebral space; b) disappearance of the herniated fragment due to dehydration and retraction mechanisms; c) gradual resorption of the herniated tissue by phagocytosis and enzymatic degradation induced by an inflammatory reaction that appeared as the disc (acting the extrusion itself as an foreign body) and, d) pulsion of cephaloarchidian liquid against the herniated portion. CONCLUSIONS: Disc herniation can regress, or even disappear, in a number of patients, rendering the radiological findings not to be taken as the only surgical indication criterium. We consider that the best treatment is the one relying on a good doctor-patient relationship, suspended in a balance between conservative and surgical treatment. According to clinical data, the first one (conservative) should not exceed the estimated time beyond which the surgical result would be unsatisfactory. The second one (operative), excepting "need-to operate" situations (such as cauda equina compression, progressive or serious motor déficit, or unbearable pain), should be prudently supedited to MRI regresión control, in particular in patients in which a clinical improvement is observed. Thus, the disc herniation conservative healing, both clinical as radiological, do exist, being a concept to widespread among clinicians and patients also.

摘要

相似文献

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[7]
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引用本文的文献

[1]
Lumbar disc herniation reabsorption: a review of clinical manifestations, mechanisms, and conservative treatments.

Front Med (Lausanne). 2025-7-28

[2]
Lumbar intervertebral disc calcification with massive herniation: a case report.

J Int Med Res. 2025-1

[3]
Clinical and radiographic features of adult calcified thoracic disc herniation: a retrospective analysis of 31 cases.

Eur Spine J. 2023-7

[4]
Ozone as Modulator of Resorption and Inflammatory Response in Extruded Nucleus Pulposus Herniation. Revising Concepts.

Int J Mol Sci. 2021-9-14

[5]
Clinical research for whether the Traditional Chinese medicine could promote the resorption of lumbar disc herniation: a randomized controlled trial.

Medicine (Baltimore). 2020-7-2

[6]
The inflammatory response in the regression of lumbar disc herniation.

Arthritis Res Ther. 2018-11-6

[7]
Regression of a symptomatic thoracic disc herniation with a calcified intervertebral disc component.

Acta Orthop Traumatol Turc. 2016-12

[8]
Spontaneous Regression of Herniated Lumbar Disc with New Disc Protrusion in the Adjacent Level.

Case Rep Orthop. 2016

[9]
Disappearing large calcified thoracic disc herniation in a patient with thalassaemia.

BMJ Case Rep. 2016-1-28

[10]
Calcific discitis with giant thoracic disc herniations in adults.

Eur Spine J. 2016-5

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