Extruded Disc: Urgent Surgery or Shall We Wait a Bit? A Case Report

Abstract

The most common cause of low back pain is lumbar disc herniation, and patients can usually return to their normal lives with conservative approaches. Although spontaneous regression is a clinical condition described in the literature in lumbar disc herniation, the underlying mechanism and time of occurrence have not yet been fully elucidated. In this report, a case with almost complete regression in the radiological image of an extruded hernia in the lumbar region after 3 months of conservative treatment is reported. Although surgical operation is considered as the primary treatment option in patients with extruded disc herniation with neurological deficits, it is important that the radiological and clinical recovery is rapid and close to complete in this case, in which it is emphasized that conservative treatment can also be a solution for the patients.

Keywords

• Magnetic Resonance Imaging
• Extruded Disc Herniation
• Spontaneous Regression

Ekstrüde Disk: Hemen Cerrahi Mi, Biraz Bekleyelim Mi? Bir Olgu Sunumu

Abstract

Bel ağrısının en sık sebebi lomber disk hernisi olup hastalar genellikle konservatif yaklaşımlar ile normal yaşantılarına dönebilirler. Spontan regresyon, lomber disk hernisinde literatürde tanımlanmış bir klinik durum olmasına karşılık, altta yatan mekanizma ve gerçekleşme zamanı henüz tam olarak aydınlatılamamıştır. Bu sunuda, lomber bölgedeki ektrüde herninin 3 aylık konservatif tedavi sonunda, radyolojik görüntüsünde tama yakın regresyon gösteren bir olgu bildirilmektedir. Nörolojik defisiti olan ekstrüde disk hernili hastalarda cerrahi operasyon öncelikli tedavi seçeneği olarak düşünülmekle beraber, konservatif tedavinin de hastalar için çözüm olabileceğinin altını çizildiği bu olguda, radyolojik ve klinik iyileşmenin hızlı ve tama yakın olması önem arzetmektedir.

Keywords

• Manyetik Rezonans Görüntüleme
• spontan regresyon
• ektrüde disk hernisi

References

1. 1.Benoist M: The natural history of lumbar disc herniation and radiculopathy. Joint Bone Spine 2002;69: 155-160.
2. 2.Çetinkal, A., Topuz, A. K., Çolak, A., Kutlay, A. M., Kaya, S., & Demircan, M. N. Travma sonrası regrese servikal disk hernisi. Ege Tıp Dergisi,2009; 48(3), 199-201.
3. 3. Teplick JG, Haksin ME.:Spontaneous regression of herniated nucleus pulposus. AJR.1985 ;145 : 371-375.
4. 4. Mochida K, Komori H, Okawa A, Muneta T, Haro H, Shinomiya K. Regression of cervical disc herniation observed on magnetic resonance images. Spine May 1998; 1;23(9):990-5.
5. 5. Reddy PK, Sathyanarayana S, Nanda A. MRI-documented spontaneous regression of cervical disc herniation : a case report and review of literature. J La State Med Soc. Mar-Apr. 2003;155(2):97-98.
6. 6. Richard M. Westmark, MD, Kaye D. Westmark, MD, Volker K. H. Sonntag, MD. Disappearing cervical disc. J Neurosurg. 1997; 86:289- 290.
7. 7.Slavin KV, Raja A, Thornton J, Wagner FC: Spontaneous regression of a large lumbar disc herniation. Surg Neurol 2001;56: 333-337.
8. 8. Doita M, Kamati T, Hamata T, Mizuno K. Immunohistologic study of the ruptured intervertebral disc of the lumbar spine. Spine1996;21(2):235-41.

9. 9. Koike Y, Uziki M, Kokubun S, Sawai T. Angiogenesis and inflammatory cell infiltration in lumbar disc herniation. Spine 2003;28(17):1928-33.
10. 10.Haro H, Kato T, Komori H, Osada M, Shinomiya K. Vasculer endothelial growth factor (VEGF)induced angiogenesis in herniated disc resorption. J Orthopaedic Research 2002;20(3):409-15.
11. 11. Borota L, Jonasson P, Agolli A. Spontaneous resorption of intradural lumbar disc fragments. Spine J 2008;8(2):397-403.
12. 12. Wasserstrom R, Mamourian AC, Black JF, Lehman RA. Intradural lumbar disk fragment with ring enhancement on MR. Am J Neuroradiol 1993;14(2):401-4.
13. 13.Komori H, Shinomiya K, Nakai O, Yamaura I, Takada S, Furuya K: The Natural History of Herniated Nucleus Pulposus with Radiculopathy. Spine 1996; 21: 225-229.
14. 14. Bozzao A, Gallucci M, Masciocchi C, Aprile I, Barile A, Passariello R. Lumbar disk herniation: MR imaging assessment of natural history in patients treated without surgery. Radiology 1992;185(1):135-41.
15. 15. Macki M, Hernandez-Hermann M, Bydon M, Gokaslan A, McGovern K, Bydon A. Spontaneous regression of sequestrated lumbar disc herniations: Literature review. Clin Neurol Neurosurg 2014; 120:136-141