Spontaneous Resolution of Sequestrated Lumbar Disc Herniation: A Prospective Cohort Study

Abstract

Objective Spontaneous regression of sequestrated lumbar disc well known entity. But, the current reports about this scenario are confined to case reports or small case series. To assess the chance of complete spontaneous resolution of sequestrated lumbar disc herniation and to report the outcome of regressed cases in a prospective study. Method From January 2010 to July 2015, 103 patients with acute lower limb mono-radiculopathy, but without neurological motor deficit secondary to a migrated lumbar disc herniation thought to be a sequestrated free disc fragment were prospectively studied for the possibility of their spontaneous regression with time. All the qualified patients initially fulfilled the study criteria. But seven patients were lost to follow up and 9 more cases preferred to do surgery within a few days to three weeks after clinical trial. Eighty seven patients remained for clinical evaluation and periodic magnetic resonance imaging for the possibility of spontaneous regression. These patients include 39 males and 48 females. The age of the patients ranged from 22 to67 years with the mean of 42.96, SD= 10.65. Results In 75 of these cases complete resolution of the offending disc occurred. This was associated with marked improvement or even disappearance of pain intensity in short and mid-term follow-up. Furthermore, where a case of same level contralateral disc herniation was seen, not a single case of same level same side recurrence could be encountered. The cost of treatment and work status of the patients were significantly better than surgically treated patients according to previously published reports. In mid-term follow, recovery rate (McNab Criteria %) of these 75 patients was either good or excellent. All these were satisfied and recommend this type of treatment for similar patients. The remaining 12 patients, ultimately underwent surgery. Surprisingly, all had subligamentous location Conclusion This study clarifies that conservative management might be considered as an appropriated cost-effective option in treatment of sequestrated lumbar disc herniation in the patients with minimal neurological impairment, with probably high chance of spontaneous regression of the offending disc. However, to compare conservative versus surgery, in this sub-type of disc herniation, further clinical trials are recommended.