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Observations on the natural history of massive lumbar disc herniation

G L Cribb1, D C Jaffray, V N Cassar-Pullicino

  • 1Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire SY10 7AG, UK. gcribb@hotmail.com

The Journal of Bone and Joint Surgery. British Volume
|July 7, 2007
PubMed

Insights

Non-operative treatment led to significant resolution of massive lumbar disc herniations in most patients. This suggests that this condition may be less severe than previously believed, offering a more hopeful outlook for patients.

Area of Science:

  • Neurosurgery
  • Orthopedics
  • Radiology

Background:

  • Massive lumbar disc herniations can cause significant pain and disability.
  • The natural history and non-operative management outcomes for these specific cases are not fully understood.

Purpose of the Study:

  • To evaluate the long-term outcomes of non-operative management for massive lumbar disc herniations.
  • To assess the rate of herniation resolution and the incidence of severe complications.

Main Methods:

  • Retrospective analysis of 15 patients with massive lumbar disc herniations treated non-operatively.
  • Serial Magnetic Resonance (MR) imaging was performed at a mean follow-up of 24 months.
  • Clinical outcomes and development of cauda equina syndrome were monitored.

Main Results:

  • Dramatic resolution of the herniation was observed in 14 out of 15 patients on repeat MR scans.
  • No patient experienced the development of cauda equina syndrome.
  • The mean follow-up period was 24 months, ranging from 5 to 56 months.

Conclusions:

  • Non-operative management appears to be a highly effective strategy for massive lumbar disc herniations.
  • Massive lumbar disc herniations may have a more benign natural course than previously assumed.
  • Conservative treatment can lead to significant radiological improvement and avoid severe neurological deficits.

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