[Lumbar disk herniation with no surgical treatment. Clinical and x-ray computed tomographic follow-up study]

The authors have studied the clinical and computed tomographic (CT) follow-up of 50 patients with nerve root symptoms and herniated nucleus pulposus (HNP) who received only a conservative medical treatment. The clinical follow-up showed that after 23 months 38 patients (76 percent) did not require surgery and 63 percent of these had good or very good results. Follow-up CT scans, performed in 20 patients, found spontaneous disappearance of NP in 10 cases and partial regression in 3 cases. Several mechanisms may explain this regression, including fragmentation and sequestration of the disc fragment, dehydration and shrinkage of the HNP and its reintegration into the annulus. On the other hand, HNP persisted in some patients who had become asymptomatic, and it was also found in an asymptomatic control subject. These data demonstrate that clinical and CT findings may be dissociated. Not all CT scan-documented HNPs require interventional therapy. Except in case of emergency, surgical treatment should be considered only after failure of conservative medical treatment and whenever clinical and CT data are concordant. CT and other imaging procedures, such as myelography and nuclear magnetic resonance, should only be used preoperatively in patients with appropriate clinical findings.