Resorption Of Disc Herniation Research Articles

Resorption of lumbar disc herniations: a non-systematic literature review

Objective. To analyze the information on spontaneous resorption of lumbar disc herniation.Material and Methods. A non-systematic review of 37 publications on resorption of disc herniation was conducted. The data on the timing, mechanisms and predictors of regression of lumbar disc herniation were summarized. A clinical case is presented illustrating the resorption of a herniated L4–L5 intervertebral disc over 8 months.Results. The frequency and timing of resorption of lumbar disc herniation vary depending on the number of patients, follow-up period, the type and nature of the hernial bulging, and other characteristics of patients. The results of meta-analyses indicate that the average period of spontaneous resorption of lumbar disc herniation is more than 6 months. The main theories of spontaneous resorption of lumbar disc herniation are the dehydration theory, the mechanical theory, and mechanisms associated with inflammatory processes and neovascularization. Currently, predictors of disc herniation resorption include the type and size of the hernia, follow-up period, Modic changes, etc. Existing data on the timing, mechanisms and predictors of resorption of lumbar disc herniation are insufficient to improve treatment tactics for this category of patients.Conclusion. Herniated lumbar intervertebral discs tend to undergo spontaneous regression which, however, is not observed in all patients. The mechanisms of resorption can be different, and the fact of resorption itself can occur in different types of hernia with different frequencies. An analysis of large data sets is necessary to more accurately determine the timing and predictors of resorption of lumbar disc hernias.

The impact of novel inflammation-preserving treatment towards lumbar disc herniation resorption in symptomatic patients: a prospective, multi-imaging and clinical outcomes study.

We performed a prospective one-year multi-imaging study to assess the clinical outcomes and rate of disc resorption in acute lumbar disc herniation (LDH) patients undergoing inflammation-preserving treatment (i.e. no NSAIDS, steroids). All patients received gabapentin to relieve leg pain, 12 sessions of acupuncture. Repeat MRI was performed, every 3months, after 12 sessions of treatment continued for those without 40% reduction in herniated disc sagittal area. Disc herniations sizes were measured on sagittal T2W MRI sequences, pre-treatment and at post-treatment intervals. Patients were stratified to fast, medium, slow, and prolonged recovery groups in relation to symptom resolution and disc resorption. Ninety patients (51% females; mean age: 48.6years) were assessed. Mean size of disc herniation was 119.54 ± 54.34mm2, and the mean VAS-Leg score was 6.12 ± 1.13 at initial presentation. A total of 19 patients (21.1%) improved at the time of the repeat MRI (i.e. within first 3months post-treatment). 100% of all patient had LDH resorption within one year (mean: 4.4. months). There was no significant difference at baseline LDH between fast, medium, slow, and prolonged resorption groups. Initial LDH size was weakly associated with degree of leg pain at baseline and initial gabapentin levels. Surgery was avoided in all cases. This is the first study to note inflammation-preserving treatment, without conventional anti-inflammatory and steroid medications, as safe and effective for patients with an acute LDH. Rate of disc resorption (100%) was higher than comparative recent meta-analysis findings (66.7%) and no patient underwent surgery.

Prediction of lumbar disc herniation resorption in symptomatic patients: a prospective, multi-imaging and clinical phenotype study

Symptomatic lumbar disc herniations (LDH) are very common. LDH resorption may occur by a "self-healing" process, however this phenomenon remains poorly understood. By most guidelines, if LDH remains symptomatic after 3 months and conservative management fails, surgical intervention may be an option. The following prospective study aimed to identify determinants that may predict early versus late LDH resorption. Prospective study with patients recruited at a single center. Ninety-three consecutive patients diagnosed with acute symptomatic LDH were included in this study (n=23 early resorption and n=67 late resorption groups) with a mean age of 48.7±11.9 years. Baseline assessment of patient demographics (eg, smoking status, height, weight, etc.), herniation characteristics (eg, the initial level of herniation, the direction of herniation, prevalence of multiple herniations, etc.) and MRI phenotypes (eg, Modic changes, end plate abnormalities, disc degeneration, vertebral body dimensions, etc.) were collected for further analysis. Lumbar MRIs were performed approximately every 3 months for 1 year from time of enrollment to assess disc integrity. All patients were managed similarly. LDH resorption was classified as early (<3 months) or late (>3 months). A prediction model of pretreatment factors was constructed. No significant differences were noted between groups at any time-point (p>.05). Patients in the early resorption group experienced greater percent reduction of disc herniation between MRI-0-MRI-1 (p=.043), reduction of herniation size for total study duration (p=.007), and percent resorption per day compared to the late resorption group (p<.001). Based on multivariate modeling, greater L4 posterior vertebral height (coeff:14.58), greater sacral slope (coeff:0.12), and greater herniated volume (coeff:0.013) at baseline were found to be most predictive of early resorption (p<.05). This is the first comprehensive imaging and clinical phenotypic prospective study, to our knowledge, that has identified distinct determinants for early LDH resorption. Early resorption can occur in 24.7% of LDH patients. We developed a prediction model for early resorption which demonstrated great overall performance according to pretreatment measures of herniation size, L4 posterior body height, and sacral slope. A risk profile is proposed which may aid clinical decision-making and managing patient expectations.

Spontaneous Resorption of Intervertebral Disc Herniations

The data on the possibility of intervertebral disc herniation regress at terms from 3 to 12 months are presented. Immune response of the organism and the factor of peripheral fibrous ring neovascularization play an important role in the process of disc herniation resorption. Transligamentous and sequesteredherniations are resorbed better than the subligamentous ones. To intensify the intervertebral disc herniation resorption it is necessary to activate microcirculation of the injured spinal motion segment.

Spontaneous Resorption of Intervertebral Disc Herniations

The data on the possibility of intervertebral disc herniation regress at terms from 3 to 12 months are presented. Immune response of the organism and the factor of peripheral fibrous ring neovascularization play an important role in the process of disc herniation resorption. Transligamentous and sequesteredherniations are resorbed better than the subligamentous ones. To intensify the intervertebral disc herniation resorption it is necessary to activate microcirculation of the injured spinal motion segment.

An Anti TNF-Α Receptor Antagonist does not Augment the Effect of Autologous Mesenchymal Stem Cell Therapy in Experimental Intervertebral Disc Degeneration in Göttingen Minipigs

Study design: Intervertebral disc degeneration (IDD) was induced surgically in 16 skeletally mature Gottingen minipigs. Autologous stem cells were transplanted 12 weeks post-operatively. Half f the animals were randomized to Humira® treatment 6 prior to 6 weeks after stem cell transplantation. Total observation was 30 weeks. Objective: To evaluate whether anti TNF-α antibody administered systemically for a short period augmented the regenerative effect of autologous stem cell therapy. Summary of Background data: Anti TNF-α treatment have been tested with regard to resorption of disc herniation and sciatica without significant effect. It is a second line treatment in inflammatory bowel disease and rheumatoid arthritis. It is thought as a pain modulator and inhibits chondrocytic differentiation. Mesenchymal stem cell therapy has some proven efficacy in regeneration of the degenerative intervertebral disc. Methods: IDD was induced by full thickness scalpel incisions in 3 levels in 16 skeletally mature Gottingen minipigs. Stem cells were harvested and purified from bone marrow and transplanted after 12 weeks. Half of the animals were randomized to short term treatment with anti TNF-α antibody (Humira®, Abbott Laboratories) for 6 weeks before to 6 weeks after stem cell treatment. Total observation was 30 weeks. MRI was performed before stem cell transplantation and before sacrifice. Quantitative real time RT-PCR and histology was performed after sacrifice. Results: Autologous stem cell transplantation was able to stop and partially reverse the degenerative process with regard to MRI index (p=0.0031), disc height (p=0.021 and 0.04) and ADC value (p=0.023). Quantitative real time RT-PCR found no difference in apoptosis markers between any of the groups. Histology showed partial degeneration in stem cell treated discs. There was no difference in any parameter between groups treated with Humira® or not. Conclusion: Autologous stem cell therapy is able to stop and partially reverse the degenerative process and survive in vivo for at least 18 weeks. Anti TNF-α treatment does not augment the effect and does not slow down the degenerative process in a minipig model of IDD.

Influence of cytokine inhibitors on concentration and activity of MMP-1 and MMP-3 in disc herniation

IntroductionSpontaneous resorption of disc herniation (DH) after sciatica is well documented. The matrix metalloproteinases (MMP)-1 and MMP-3 are enzymes potentially involved in this process. Glucocorticoid injections are commonly used for treatment, and other anti-inflammatory molecules like tumor necrosis factor (TNF) inhibitors are under clinical investigation. However, little is known about the effect of these molecules on DH resorption.MethodsDH tissue was harvested from patients undergoing surgery for sciatica. Samples were thoroughly washed. Diced explants were cultured ex-vivo in 1) 0.5 ml Dulbecco's modified Eagle's medium (DMEM) 10% fetal calf serum (FCS), (controls), 2) recombinant interleukin 1 receptor antagonist (IL-1Ra), (100 ng/ml), 3) dexamethasone (10E-5 M), or 4) TNF inhibitor monoclonal antibody (10 μg/ml). Supernatants were harvested at 48 hours and frozen. Immunocapture activity assays determined total MMP activity, active MMP levels and pro-MMP levels.ResultsFourteen DH tissue samples were analysed. Levels of all forms of MMP-3 were higher than the respective levels of MMP-1(P < 0.01). In particular, the median (interquartile range [IQR]) total MMP-3 level was 0.97 (0.47 - 2.19) ng/mg of tissue compared to 0.024 (0.01 - 0.07) ng/mg of total MMP-1 level (P < 0.01). Incubation with IL-1Ra, dexamethasone, or TNF inhibitors significantly decreased levels of all forms of MMP-3 (P < 0.05). Dexamethasone significantly decreased the ratio of active MMP-3 to total MMP-3 activity. A significant inhibitory effect of dexamethasone was observed only on active MMP-1, while IL-1 and TNF inhibitor had no significant effect on any form.ConclusionsMMP-3 appears to play a greater role than MMP-1 in DH resorption. Dexamethasone, IL-1-Ra and TNF inhibitor decreased active MMP-3, indicating that the clinical use of these drugs may affect the resorption of DH under certain conditions.

The Effect of Infliximab, a Monoclonal Antibody Against TNF-α, on Disc Herniation Resorption

Randomized, controlled study. To evaluate the effect of infliximab on herniated nucleus pulposus (HNP) resorption. Although the effects of tumor necrosis factor alpha (TNF-alpha) on HNP resorption are not fully understood, TNF-alpha appears to be an essential mediator in HNP resorption. As part of a substudy of the FIRST II study, magnetic resonance images (MRIs) were obtained from 21 patients who were candidates for discectomy at weeks 0, 2, 12, and 26 after receiving a single infusion of either 5 mg/kg infliximab (11 patients) or placebo (10 patients). The volume (mm3) of HNP, thickness (mm) and extent (%) of rim enhancement, and presence of nerve root edema were assessed. HNP volume decreased significantly from baseline to 6 months in both treatment groups (P < 0.01), with no difference noted between the infliximab and placebo groups. By week 2, rim enhancement thickness increased significantly in the infliximab group compared with the placebo group (P = 0.003). Two patients in each group required back surgery before the 6-month assessment. Infliximab did not appear to interfere with disc herniation resorption over a 6-month period.