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Intervertebral disc herniation refers to the displacement of the nucleus pulposus (the gel-like inner core of the disc) through a tear or weakened area in the annulus fibrosus (the outer fibrous ring). The displaced disc material extends beyond the normal boundaries of the disc space and may compress or irritate nearby spinal nerve roots or, less commonly, the spinal cord.Etiology and Risk FactorsHerniation commonly results from degeneration, in which aging reduces disc hydration and...
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Related Experiment Video

Updated: Jun 19, 2026

Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability
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Published on: July 25, 2025

Conservatively treated massive prolapsed discs: a 7-year follow-up.

R T Benson1, S P Tavares, S C Robertson

  • 1Department of Orthopaedics, Royal Berkshire Hospital, Reading, UK. richard.benson@ndos.ox.ac.uk

Annals of the Royal College of Surgeons of England
|November 6, 2009
PubMed
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Conservative management of massive lumbar herniated nucleus pulposus (HNP) shows high recovery rates. Even large herniated discs can improve significantly without surgery if initial clinical progress is observed.

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Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Radiology

Background:

  • The natural history and optimal management of lumbar herniated nucleus pulposus (HNP) remain unclear.
  • Large disc herniations are often presumed to require surgical intervention.
  • Existing literature suggests larger discs may have a greater tendency to resolve naturally.

Purpose of the Study:

  • To evaluate the safety and efficacy of conservative management for massive lumbar HNP.
  • To determine if clinical improvement in patients with large HNP predicts favorable outcomes.
  • To assess disc volume changes using serial MRI in patients managed conservatively.

Main Methods:

  • A cohort of 37 patients with massive lumbar HNP and initial clinical improvement was studied.
  • Clinical assessments included Lasegue test, neurological appraisal, and Oswestry Disability Index (ODI).
  • Serial MRI scans were used to measure changes in herniated disc volume over 2 years.

Main Results:

  • 83% of patients achieved complete and sustained recovery at an average follow-up of 23.2 months.
  • The average ODI improved significantly from 58% to 15%.
  • Serial MRI revealed an average 64% reduction in disc herniation volume, with poor correlation to clinical improvement.

Conclusions:

  • Massive lumbar HNP can have a favorable clinical course with conservative treatment.
  • Early clinical improvement in patients with large HNP indicates a very good long-term prognosis.
  • Conservative management is a viable option for massive lumbar disc herniations presenting with initial clinical progress.