How do disc herniations change over time?

• Apr 28, 2016 • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Last week I shared a popular before/after picture from the New England Journal of Medicine showing the complete remission of a lumbar disc herniation (see Hong). This was a reassuring and interesting example of how herniations are not necessarily a big deal, and I place a high value on being reassuring about back pain.

Of course, I don't want to be too reassuring. Several folks pointed out that not all herniated discs retreat back to their home between the vertebra. Indeed, probably most don't. So, how about some real data, some hard numbers on how herniations change over time? I give you: Kjaer 2016, “the first study to investigate changes in the size of lumbar disc herniations” over a long period. See the bibliography item for full details, but the upshot was: 65% did not change, 17.5% resolved, 5% fluctuated (weird), and only 12.5% got worse. Those numbers are not awesome numbers — obviously herniations do not all magically go away — but I do think they are different and much less discouraging numbers than most people have in their heads, I think.

Not that herniation severity correlates well with pain or predicts recovery in the first place.

Of course, I have now cited Kjaer et al in my low back pain tutorial.