The probability of spontaneous regression of lumbar herniated disc: a systematic review
Two articles on PainSci cite Chiu 2015: (1) Complete Guide to Low Back Pain (2) MRI and X-Ray Often Worse than Useless for Back Pain
PainSci notes on Chiu 2015:
Not only do many lumbar disc herniations resolve on their own, or with just a little help from conservative therapy, but the worse the herniation the more likely it is to regress: exactly the opposite of what common sense predicts! This systematic review of 31 studies revealed 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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- “Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis,” Ming Zhong, Jin-Tao Liu, Hong Jiang, Wen Mo, Peng-Fei Yu, Xiao-Chun Li, and Rui Rui Xue, Pain Physician, 2017.
- “Resolution of Lumbar Disk Herniation without Surgery,” Jennifer Hong and Perry A Ball, NEJM.org.
- “Progression of lumbar disc herniations over an eight-year period in a group of adult Danes from the general population: a longitudinal MRI study using quantitative measures,” Per Kjaer, Andreas Tunset, Eleanor Boyle, and Tue Secher Jensen, BMC Musculoskeletal Disorders, 2016.
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- “Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations,” W Brinjikji, P H Luetmer, B Comstock, B W Bresnahan, L E Chen, R A Deyo, S Halabi, J A Turner, A L Avins, K James, J T Wald, D F Kallmes, and J G Jarvik, AJNR Am J Neuroradiol, 2015.
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Specifically regarding Chiu 2015:
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Relationships Between Sleep Quality and Pain-Related Factors for People with Chronic Low Back Pain: Tests of Reciprocal and Time of Day Effects. Gerhart 2017 Ann Behav Med.
- Modulation in the elastic properties of gastrocnemius muscle heads in individuals with plantar fasciitis and its relationship with pain. Zhou 2020 Sci Rep.
- Association Between Plantar Fasciitis and Isolated Gastrocnemius Tightness. Nakale 2018 Foot Ankle Int.
- No Added Benefit of Combining Dry Needling With Guideline-Based Physical Therapy When Managing Chronic Neck Pain: A Randomized Controlled Trial. Stieven 2020 J Orthop Sports Phys Ther.
- Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial. Munteanu 2015 Br J Sports Med.