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Intervertebral disc injuries spontaneously regress surprisingly often — and worse ones more!

PainSci » bibliography » Chiu et al 2015
Tags: etiology, radiculopathy, sciatica, neat, counter-intuitive, back pain, spine, leg, correlation with signs, resorption, pro, neuropathy, pain, pain problems, buttocks, hip, herniation, limbs, imaging, diagnosis

Two articles on PainSci cite Chiu 2015: 1. The Complete Guide to Low Back Pain2. MRI and X-Ray Often Worse than Useless for Back Pain

Diagrammatic illustration of a lumbar disc extrusion, showing the nucleus pulposus just barely emerging from a rupture in the annulus fibrosus.

A whopping 70% of intervertebral disc extrusions spontaneously regress & 15% completely resolve.

PainSci notes on Chiu 2015:

Not only do many lumbar disc herniations (and extrusions and so on) resolve on their own, or with just a little help from conservative therapy, but the worse the herniation the more likely it is to spontaneously regress! This is exactly the opposite of what common sense predicts. This systematic review of thirty studies reveals a strong pattern of better regression from the worst cases:

“Patients with disc extrusion and sequestration had a significantly higher possibility of having spontaneous regression than did those with bulging or protruding discs.”

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: To determine the probability of spontaneous disc regression among each type of lumbar herniated disc, using a systematic review.

DATA SOURCES: Medline, Cochrane Library, CINAHL, and Web of Science were searched using key words for relevant original articles published before March 2014. Articles were limited to those published in English and human studies.

REVIEW METHODS: Articles had to: (1) include patients with lumbar disc herniation treated conservatively; (2) have at least two imaging evaluations of the lumbar spine; and (3) exclude patients with prior lumbar surgery, spinal infections, tumors, spondylolisthesis, or spinal stenosis. Two reviewers independently extracted study details and findings. Thirty-one studies met the inclusion criteria. Furthermore, if the classification of herniation matched the recommended classification of the combined Task Forces, the data were used for combined analysis of the probability of disc regression of each type. Nine studies were applicable for probability calculation.

RESULTS: The rate of spontaneous regression was found to be 96% for disc sequestration, 70% for disc extrusion, 41% for disc protrusion, and 13% for disc bulging. The rate of complete resolution of disc herniation was 43% for sequestrated discs and 15% for extruded discs.

CONCLUSIONS: Spontaneous regression of herniated disc tissue can occur, and can completely resolve after conservative treatment. Patients with disc extrusion and sequestration had a significantly higher possibility of having spontaneous regression than did those with bulging or protruding discs. Disc sequestration had a significantly higher rate of complete regression than did disc extrusion.

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