Nucleus Pulposus Resorption Following a Paraspinal Hook-Needle Intervention for Lumbar Disc Herniation: A Case Report

The paraspinal hook-needle intervention is a minimally invasive needle-based procedure performed under local anesthesia using a specialized hook-shaped needle at clinically selected lumbar segments. We report the case of a 70-year-old woman who presented with intermittent low back pain for more than 10 years, recently aggravated and accompanied by pain and numbness in the left lower limb for two weeks. Lumbar magnetic resonance imaging revealed disc herniation at L4/5 and L5/S1 with compression of the left L5 nerve root, along with a nodular intracanalar lesion at the L4/5 level suggestive of a sequestered nucleus pulposus. Following the paraspinal hook-needle intervention, the patient experienced marked relief of low back pain and radicular symptoms, with restoration of normal gait. Physical examination demonstrated significant improvement in lumbar range of motion and substantial reduction in paraspinal muscle tension and tenderness. Muscle strength of ankle dorsiflexion and the extensor hallucis longus recovered to grade V, and sensory deficits in the L4-S1 dermatomes were markedly improved. The straight-leg raise test improved to 70° without significant radicular pain. The visual analog scale score decreased from 7 to 3, and the Oswestry Disability Index score decreased from 57% to 23%. No recurrence or adverse events were observed during the 1-year follow-up period. This case documents clinical improvement after a paraspinal hook-needle intervention and subsequent radiographic disappearance of sequestered nucleus pulposus. Nevertheless, spontaneous resorption is a recognized feature of the natural history of lumbar disc herniation and cannot be excluded in this patient. Therefore, the observed temporal association should not be interpreted as evidence of causality or established efficacy, and prospective controlled studies are needed to evaluate the safety and potential clinical role of this procedure.