One of the issues I get the most questions on is low back pain,
especially disc herniations. While there is a lot that goes into this
question, two things I usually mention are that disc herniations are
common in much of the asymptomatic population and that they can heal
with time and conservative treatment.
The following is a case
report from the New England Journal of Medicine that documents the
resolution of a lumbar herniation without surgery.
29-year-old woman presented to the spine clinic with new-onset pain in
her right leg, accompanied by paresthesia. MRI of the lumbar spine
revealed a lumbar disc herniation resulting in substantial spinal
stenosis and nerve-root compression (left image).
elected conservative treatment with physical therapy and an epidural
injection of glucocorticoids. A second MRI obtained at follow-up 5
months after presentation showed resolution of the herniation (right
image). Her clinical symptoms resolved, and she was discharged from the
clinic, with follow-up recommended as needed.
from clinical trials suggest that patients who have herniated lumbar
discs have similar long-term outcomes whether they undergo surgery or
elect conservative management. In addition, the risk of subsequent
catastrophic worsening without surgery is minimal.
📚Hong J and Ball PA. Resolution of Lumbar Disk Herniation without Surgery. N Engl J Med. 2016.