Zhao Yan, Jia Zhiwei, Aili Abudunaibi, Muheremu Aikeremujiang
Department of Rehabilitative Medicine, Orthopedic Research Center, and the Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Ürümqi, China.
Department of Orthopedics, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China.
J Orthop Surg Res. 2025 May 27;20(1):528. doi: 10.1186/s13018-025-05959-x.
Spontaneous resorption of lumbar disk herniation (LDH) presents a promising avenue for the non-surgical management of herniated disks. Here we present a 40-year-old female with severe L5/S1 herniation who experienced spontaneous resorption confirmed by MRI. The patient adhered to a comprehensive non-operative treatment regimen comprising NSAIDs, heat therapy, massage therapy, acupuncture, and kinesitherapy. Over two years, the patient showed substantial clinical improvement, with significant pain reduction and MRI evidence of disk resorption, resulting in a marked decrease in their visual analog scale (VAS) pain scores. Through a systematic review of existing literature, we identify that spontaneous resorption is associated with mechanisms such as inflammation, neovascularization, macrophage infiltration, matrix degradation, disruption of immune privilege, apoptosis and autophagy, and disc dehydration. Clinical predictors for spontaneous resorption of LDH include the size, type and composition of the herniation, rim enhancement on contrast-enhanced MRI, and involvement of the posterior longitudinal ligament (PLL). Future research should focus on elucidating the molecular mechanisms of resorption, regulation of inflammatory response, macrophage polarization, matrix degradation, immune privilege and neovascularization, developing advanced imaging techniques to predict resorption potential, and exploring personalized treatment strategies based on machine learning and deep learning prediction models.
腰椎间盘突出症（LDH）的自发吸收为椎间盘突出的非手术治疗提供了一条有前景的途径。在此，我们报告一名40岁患有严重L5/S1椎间盘突出症的女性，其经MRI证实经历了自发吸收。该患者坚持综合非手术治疗方案，包括使用非甾体抗炎药、热疗、按摩疗法、针灸和运动疗法。在两年多的时间里，患者临床症状有显著改善，疼痛明显减轻，且MRI显示椎间盘吸收，其视觉模拟量表（VAS）疼痛评分显著降低。通过对现有文献的系统综述，我们发现自发吸收与炎症、新生血管形成、巨噬细胞浸润、基质降解、免疫豁免破坏、细胞凋亡和自噬以及椎间盘脱水等机制有关。LDH自发吸收的临床预测因素包括突出的大小、类型和成分、增强MRI上的边缘强化以及后纵韧带（PLL）受累情况。未来的研究应集中于阐明吸收的分子机制、炎症反应调节、巨噬细胞极化、基质降解、免疫豁免和新生血管形成，开发先进的成像技术以预测吸收潜力，并探索基于机器学习和深度学习预测模型的个性化治疗策略。
