Spontaneous Resorption of Sequestrated Intervertebral Disc Herniation

• Published in: World neurosurgery Vol. 77; no. 1; pp. 146 - 152
• Main Authors: Orief, Tamer, Orz, Yasser, Attia, Walid, Almusrea, Khaled
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2012
• Subjects: Adult; Cervical; Disc; Female; Humans; Hypesthesia - etiology; Intervertebral Disc Displacement - pathology; Intervertebral Disc Displacement - physiopathology; Low Back Pain - etiology; Lumbar; Magnetic Resonance Imaging; Male; Middle Aged; Neck Pain - etiology; Neurosurgery; Predictive Value of Tests; Pregnancy; Remission, Spontaneous; Resorption; Sciatica - etiology; Sequestrated; Spine - pathology; Spontaneous; Magnetic resonance imaging; Disc; MRI; Spontaneous; Cervical; Resorption; Sequestrated; Lumbar
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2011.04.021

Objective The aim of this study is to describe six cases with spontaneous resorption of sequestrated intervertebral disc herniation observed using magnetic resonance imaging. In addition, the possible mechanisms, predictive factors of spontaneous disappearance of the sequestrated disc herniation, and the proper surgical timing were discussed and reviewed in literature. Methods All the studied cases experienced acute radicular pain due to sequestrated intervertebral disc herniation; they refused surgery and were treated conservatively, and they were followed up neurologically and radiologically in the outpatient clinic in regular visits. Results The studied cases included five cases with lumbar disc herniation (three at level L4-5 and two at level L5-S1) and one case with cervical disc herniation at level C5-6. All patients recovered from their radicular pain within 3 to 6 weeks, and it was correlated with resorption of their sequestrated intervertebral disc herniation as documented in their follow-up magnetic resonance imaging at 4 to 9 months. Conclusions We found that sequestrated disc herniation has potential for regression, which can be clearly demonstrated by magnetic resonance imaging, because of having higher water content, and therefore, may regress through both dehydration and inflammation-mediated resorption. We suggest conservative treatment in the initial course of the sequestrated type of disc herniation for at least 2 months before recommending surgical intervention unless severe neurologic deterioration takes place.