Spontaneous Resolution of an Extraforaminal Lumbar Disc Herniation; Report of a Case and Review of the Literature

Abstract

Extraforaminal lumbar disc herniations (ELDHs) are a relatively uncommon cause of lumbar radiculopathy. In the patients suffering this kind of disc herniation, severe intractable radiculopathy due to dorsal root ganglion compression usually leads to surgery. However, although the value of conservative strategy for spontaneous resolution of intracanal lumbar sequestrated disc herniation is a well-known scenario, but it is not verified in extraforaminal disc herniation. Herein, a 53-year-old man with severe left -sided femoral radiculopathy at the vicinity of L3 which was associated with decreased knee jerk is presented. MRI revealed a huge extraforaminal disc herniation at L3-L4 level on the right side. Surgery was recommended, but since the patient was reluctant to undergo surgery, a period of conservative treatment, with transforaminal block, combined with NSAID’s prescription result in dramatic pain amelioration. Control MRI after 3 months showed relative hyperintensity of the corresponding disc. However, MRI at 9- months follow -up where the patient was completely pain free, revealed disappearance of the offending disc. To our knowledge, the scenario of spontaneous resolution of extraforaminal disc herniation has not been reported previously in the literature.