[Spontaneous regression of lumbar disk hernia]

Area of Science:

• Neurosurgery
• Radiology
• Orthopedics

Background:

• Herniated nucleus pulposus (HNP) is a common cause of severe lumbago.
• Spontaneous regression of HNP, while documented, is not fully understood.
• Conservative medical treatment is often the initial approach for HNP.

Purpose of the Study:

• To describe cases of spontaneous regression of HNP following conservative treatment.
• To compare the timing and location of spontaneous HNP regression with existing literature.
• To evaluate the suitability of conservative management for small, contained HNP.

Main Methods:

• Case series of four patients (3 female, 1 male) with severe lumbago due to HNP.
• Initial diagnosis and follow-up assessment using computed tomography (CT) scans.
• Evaluation of symptom regression over an average period of 14 months.

Main Results:

• Four cases of spontaneous HNP regression were observed after conservative medical treatment.
• Regression occurred over an average of 14 months, with the most common location being the last lumbar intervertebral space.
• One patient aged 59, older than the typical reported mean age of 35, experienced regression.

Conclusions:

• Spontaneous regression of HNP is a viable outcome of conservative treatment.
• The hypothesis of dehydration and atrophy of the herniated nucleus pulposus is supported by findings like the vacuum disk phenomenon.
• Conservative, 'waiting tactics' are justified for small HNP contained by an intact posterior longitudinal ligament.