Spontaneous Regression Of A Large Sequestered Lumbar Disc Herniation: A Case Report And Literature Review
Hu, C., Lin, B., Li, Z., Chen, X., & Gao, K. (2021). Spontaneous regression of a large sequestered lumbar disc herniation: a case report and literature review. The Journal of international medical research, 49(11), 3000605211058987. https://doi.org/10.1177/03000605211058987
View Original Source →Abstract
Lumbar disc herniation is a common disorder in adults that is accompanied by lower back and radicular pain. A 32-year-old man visited our clinic with 1-week history of persistent lower back pain and weakness in his right big toe. Magnetic resonance imaging (MRI) of his lumbar spine revealed herniated discs at L3/L4, L5/S1 and L4/L5, where a right-sided intraspinal mass lesion deep to the L4 vertebral body was causing compression of the nerve root. The patient underwent conservative treatment and reported no symptoms referrable to his back or leg 4 months later. Follow-up MRI showed no herniation of the nucleus pulposus at the L4/L5 level or lesion deep to the vertebral body of L4, whereas no changes had occurred to the status of the herniated L3/L4 and L5/S1 discs. The present case and a literature review show that a sequestered lumbar disc herniation can regress within a relatively short timeframe without surgery. The authors emphasise the utility of conservative therapy for patients who do not have a definitive surgical indication.
Case Details
Disease Location
Lumbar intervertebral discs
Personal Characteristics
32-year-old man
Clinical Characteristics
1-week history of persistent lower back pain and weakness in his right big toe. Physical examination showed muscle weakness (grade 3/5) of his right extensor hallucis longus, with reductions in sensation over the l4 dermatome and the ability to raise his lower right leg by 40 degrees. MRI of his lumbar spine revealed herniated discs at l3/l4, l5/s1 and l4/l5, where there was a right-sided intraspinal mass-like lesion that extended deep to the l4 vertebral body, which was causing compression of the nerve root. The patient declined surgery in favour of conservative treatment, and agreed to undergo physical therapy, to sleep on a hard/firm mattress and to perform exercises
Remission Characteristics
At 4 months follow-up examination, both physical examination and the straight- leg raising test yielded normal results, and MRI showed no herniation of the nucleus pulposus at the l4/l5 level.
Treatment & Mechanisms
Proposed Remission Mechanisms
Both dehydration and inflammation and neovascularisation may be involved in the process of disc herniation, and especially in nucleus pulposus herniation.
Clinical Treatment
Physical therapy exercise
Non-Clinical Treatment
Acupuncture massage hard mattres