Thursday, February 8, 2018

Disc Herniations Can Heal Without Surgery

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.
📕A 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).
📕She 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.
📕Data 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.

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