Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2016; 35(01): 070-073
DOI: 10.1055/s-0035-1570496
Case Report | Relato de Caso
Thieme Publicações Ltda Rio de Janeiro, Brazil

Extruded Lumbar Disc Herniation with Spontaneous Reabsorption: Case Report and Review

Reabsorção espontânea de hérnia discal lombar extrusa: relato de caso
Carlos Eduardo da Silva
1   Director, Neurosurgery and Skull Base Surgery Department, Hospital Ernesto Dornelles, Porto Alegre, RS, Brazil
,
Paulo Eduardo P. de Freitas
2   Neurosurgeon, Neurosurgery and Skull Base Surgery Department, Hospital Ernesto Dornelles, Porto Alegre, RS, Brazil
,
Matheus V. Fernandes
3   Medical Academic, Neurosurgery and Skull Base Surgery Department, Hospital Ernesto Dornelles, Porto Alegre, RS, Brazil
,
Matheus F. Gomes
3   Medical Academic, Neurosurgery and Skull Base Surgery Department, Hospital Ernesto Dornelles, Porto Alegre, RS, Brazil
,
Alex Spassim
3   Medical Academic, Neurosurgery and Skull Base Surgery Department, Hospital Ernesto Dornelles, Porto Alegre, RS, Brazil
,
Ademar S. Mesquita Jr
3   Medical Academic, Neurosurgery and Skull Base Surgery Department, Hospital Ernesto Dornelles, Porto Alegre, RS, Brazil
,
Geniffer C. Cardoso
3   Medical Academic, Neurosurgery and Skull Base Surgery Department, Hospital Ernesto Dornelles, Porto Alegre, RS, Brazil
,
Gustavo S. Raupp
3   Medical Academic, Neurosurgery and Skull Base Surgery Department, Hospital Ernesto Dornelles, Porto Alegre, RS, Brazil
,
Leonardo D. Olijnyk
4   Resident, Neurosurgery and Skull Base Surgery Department, Hospital Ernesto Dornelles, Porto Alegre, RS, Brazil
› Author Affiliations
Further Information

Publication History

04 October 2014

28 August 2015

Publication Date:
08 April 2016 (online)

Abstract

Disc herniation is a common condition in the population and has a direct impact on the quality of life in patients, also causing functional limitations in the work place. Treatment protocols include conservative management and/or various surgical interventions. This paper reports on a case of symptomatic large extruded disc herniation, together with spontaneous clinical regression and total re-absorption. We show here conservative management, and a literature review of the main pathophysiological hypotheses for such an unusual evolution.

Resumo

Hérnia discal é condição comum na população e tem impacto direto na qualidade de vida dos pacientes, assim como causa limitações funcionais em seu ambiente de trabalho. Protocolos de tratamento incluem manejo conservador e/ou diversos tipos de intervenção cirúrgica. Este artigo relata o caso de uma extensa hérnia extrusa sintomática, juntamente a sua regressão clínica espontânea e sua total reabsorção. Descrevemos também seu manejo conservador e uma revisão da literatura para a principal hipótese diagnóstica nesta evolução incomum.

 
  • References

  • 1 Vialle LRV, Emiliano N, Henao JES, Giraldo G. Hérnia discal lombar. Rev Bras Ortop 2010; 45 (1) 17-22
  • 2 Carvalho MEI, Carvalho Junior RM, Carvalho RA, Paula Junior AR. Limitação funcional em pacientes com hérnia discal lombar e o impacto na vida laboral. Terapia Manual 2010; 38 (8) 320-324
  • 3 Teplick JG, Haskin ME. Spontaneous regression of herniated nucleus pulposus. AJR Am J Roentgenol 1985; 145 (2) 371-375
  • 4 Sabuncuoğlu H, Ozdoğan S, Timurkaynak E. Spontaneous regression of extruded lumbar disc herniation: report of two illustrative case and review of the literature. Turk Neurosurg 2008; 18 (4) 392-396
  • 5 Ellenberg M, Reina N, Ross M, Chodoroff G, Honet JC, Gross N. Regression of herniated nucleus pulposus: two patients with lumbar radiculopathy. Arch Phys Med Rehabil 1989; 70 (12) 842-844
  • 6 Fager CA. Observations on spontaneous recovery from intervertebral disc herniation. Surg Neurol 1994; 42 (4) 282-286
  • 7 Komori H, Shinomiya K, Nakai O, Yamaura I, Takeda S, Furuya K. The natural history of herniated nucleus pulposus with radiculopathy. Spine 1996; 21 (2) 225-229
  • 8 Slavin KV, Raja A, Thornton J, Wagner Jr FC. Spontaneous regression of a large lumbar disc herniation: report of an illustrative case. Surg Neurol 2001; 56 (5) 333-336 , discussion 337
  • 9 Guinto Jr FC, Hashim H, Stumer M. CT demonstration of disk regression after conservative therapy. AJNR Am J Neuroradiol 1984; 5 (5) 632-633
  • 10 Doita M, Kanatani T, Harada T, Mizuno K. Immunohistologic study of the ruptured intervertebral disc of the lumbar spine. Spine 1996; 21 (2) 235-241
  • 11 Hirabayashi S, Kumano K, Tsuiki T, Eguchi M, Ikeda S. A dorsally displaced free fragment of lumbar disc herniation and its interesting histologic findings. A case report. Spine 1990; 15 (11) 1231-1233
  • 12 Ito T, Yamada M, Ikuta F , et al. Histologic evidence of absorption of sequestration-type herniated disc. Spine 1996; 21 (2) 230-234
  • 13 Haro H, Crawford HC, Fingleton B , et al. Matrix metalloproteinase-3-dependent generation of a macrophage chemoattractant in a model of herniated disc resorption. J Clin Invest 2000; 105 (2) 133-141
  • 14 Doita M, Kanatani T, Ozaki T, Matsui N, Kurosaka M, Yoshiya S. Influence of macrophage infiltration of herniated disc tissue on the production of matrix metalloproteinases leading to disc resorption. Spine 2001; 26 (14) 1522-1527
  • 15 Henmi T, Sairyo K, Nakano S , et al. Natural history of extruded lumbar intervertebral disc herniation. J Med Invest 2002; 49 (1–2) 40-43
  • 16 Burke JG, Watson RW, McCormack D, Dowling FE, Walsh MG, Fitzpatrick JM. Spontaneous production of monocyte chemoattractant protein-1 and interleukin-8 by the human lumbar intervertebral disc. Spine 2002; 27 (13) 1402-1407
  • 17 Carreon LY, Ito T, Yamada M, Uchiyama S, Takahashi HE. Neovascularization induced by annulus and its inhibition by cartilage endplate. Its role in disc absorption. Spine 1997; 22 (13) 1429-1434 , discussion 1446–1447
  • 18 Minamide A, Hashizume H, Yoshida M, Kawakami M, Hayashi N, Tamaki T. Effects of basic fibroblast growth factor on spontaneous resorption of herniated intervertebral discs. An experimental study in the rabbit. Spine 1999; 24 (10) 940-945
  • 19 Weber H. Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine 1983; 8 (2) 131-140
  • 20 Atlas SJ, Keller RB, Chang Y, Deyo RA, Singer DE. Surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: five-year outcomes from the Maine Lumbar Spine Study. Spine 2001; 26 (10) 1179-1187
  • 21 Saal JA, Saal JS. Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy. An outcome study. Spine 1989; 14 (4) 431-437
  • 22 Takada E, Takahashi M, Shimada K. Natural history of lumbar disc hernia with radicular leg pain: Spontaneous MRI changes of the herniated mass and correlation with clinical outcome. J Orthop Surg (Hong Kong) 2001; 9 (1) 1-7
  • 23 Ahn SH, Ahn MW, Byun WM. Effect of the transligamentous extension of lumbar disc herniations on their regression and the clinical outcome of sciatica. Spine 2000; 25 (4) 475-480
  • 24 Komori H, Okawa A, Haro H, Muneta T, Yamamoto H, Shinomiya K. Contrast-enhanced magnetic resonance imaging in conservative management of lumbar disc herniation. Spine 1998; 23 (1) 67-73
  • 25 Yamashita K, Hiroshima K, Kurata A. Gadolinium-DTPA—enhanced magnetic resonance imaging of a sequestered lumbar intervertebral disc and its correlation with pathologic findings. Spine 1994; 19 (4) 479-482
  • 26 Buttermann GR. Lumbar disc herniation regression after successful epidural steroid injection. J Spinal Disord Tech 2002; 15 (6) 469-476
  • 27 Orief T, Orz Y, Attia W, Almusrea K. Spontaneous resorption of sequestrated intervertebral disc herniation. World Neurosurg 2012; 77 (1) 146-152
  • 28 Rothoerl RD, Woertgen C, Brawanski A. When should conservative treatment for lumbar disc herniation be ceased and surgery considered?. Neurosurg Rev 2002; 25 (3) 162-165