Abstract

Objective:To evaluate the natural history of lumbar extruded disc with conservative treatment on MRI and to assess relation between the radiologic changes and clinical outcome.Methods:This prospective observational study was conducted at University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital between May 2015-June 2018. It included consecutive patients who were diagnosed as having lumbar symptomatic extruded disc as shown in MRI. After an average period of 17.0±7.2 months, repeat MRI was taken in 40 patients who received only conservative care during follow-up. Changes in the volume of herniated disc was measured. The patients were assigned into 3 groups as follow: (1) non-regression, (2) partial-regression, and (3) complete resolution. Numeric Rating Scale (NRS) pain score, the Oswestry Low Back Pain Disability Index (ODI) and muscle weakness were evaluated.Results:Based on disc volume of the T2-weighted MR images; four patients (10%) did not show any regression, six patients (15%) had a partial regression, and 30 patients (75%) had a complete resolution. Patients with complete resolution showed a significant improvement in the NRS pain score and the ODI score (p<0,001) over time. In patients with partial regression, only the ODI score improved significantly (p=0,043). Non-regression group did not show any improvement in any clinical outcome measure (p>0,05). Changes in the NRS scores over time were significantly higher in complete resolution group compared to non-regression group (p=0.016).Conclusion:The majority of the patients with extruded lumbar disc herniation might have reduction in size of herniated disc in the long run along with improvement in symptoms and function with conservative care.

Highlights

  • Lumbar disc herniation is a common disorder that causes disability and poor quality of life by limiting functional capacity

  • The extruded lumbar disc herniation might generally be considered to be a schedule for surgical treatment, but most of the cases are suggested to be treated successfully by conservative treatment options.[1]

  • Patients with complete resolution showed a significant improvement in the Numeric Rating Scale (NRS) pain score and the Oswestry Low Back Pain Disability Index (ODI) score (p

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Summary

Introduction

Lumbar disc herniation is a common disorder that causes disability and poor quality of life by limiting functional capacity. The extruded lumbar disc herniation might generally be considered to be a schedule for surgical treatment, but most of the cases are suggested to be treated successfully by conservative treatment options.[1]. In 1984, Guinto FC Jr et al.[2] reported the first case of spontaneous regression of lumbar disc herniation This condition has been described ranging 35%-100% for all grades of disc herniation in many studies.[3] Lumbar disc herniation is enclosed by a granulation tissue comprising newly formed vessels and infiltrating macrophages. Disc morphology changes over time was shown using MRI in patients with lumbar disc herniation treated conservatively.[6,7,8] MRI studies demonstrated that migrated and extruded disc herniation were more reduced in size.[9,10]

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