Regression in the Symptoms and Discal Hernia in Case of Lumbar Radiculopathy

M. A. Ivanova; V. A. Parfenov; Ekaterina Silina; A. I. Isaykin

doi:10.3889/oamjms.2020.3772

Authors

M. A. Ivanova Department of Nervous Diseases and Neurosurgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya Street, 119991, Moscow, Russia
V. A. Parfenov Department of Nervous Diseases and Neurosurgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya Street, 119991, Moscow, Russia
Ekaterina Silina Department of Nervous Diseases and Neurosurgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya Street, 119991, Moscow, Russia
A. I. Isaykin Department of Nervous Diseases and Neurosurgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8-2 Trubetskaya Street, 119991, Moscow, Russia

DOI:

https://doi.org/10.3889/oamjms.2020.3772

Keywords:

lumbar discogenic radiculopathy, regression of discal hernia, magnetic resonance imaging

Abstract

BACKGROUND: Discogenic lumbar radiculopathy has a favorable potential for survival; the regression of clinical symptoms may outpace the subsidence of discal hernia.

AIM: The objective of the study is comparing the clinical data and the results of magnetic resonance imaging (MRI) in patients with discogenic lumbar radiculopathy over 1 year of observation.

MATERIALS AND METHODS: Thirty-two patients (13 males at the average age of 39.1 ± 11.8 years) with discogenic lumbar radiculopathy confirmed by MRI were examined in the study. The intensity of pain condition was assessed using the numerical rating scale; disability was assessed using the Oswestry disability index. Sixteen patients were subjected to repeated MRI.

RESULTS: Statistically significant (p < 0.01) reduction of the average pain intensity and intensity of disability more than 2 times was observed as early as in the first 2 weeks. Gradual reduction of pain and disability was observed during the year. Reduction of discal hernia by more than 50% was observed on average after 8.7 ± 4.7 months.

CONCLUSION: In the case of discogenic radiculopathy, the reduction of pain and related disability far outstrips the regression of the herniation of intervertebral disk.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Driscoll T, Jacklyn G, Orchard J, Passmore E, Vos T, Freedman G, et al. The global burden of occupationally related low back pain: Estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):975-81. https://doi. org/10.1136/annrheumdis-2013-204631 PMid:24665117

Vos T, Abajobir AA, Abate KH. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: A systematic analysis for the global burden of disease study 2016. Glob Heal Metr. Lancet. 2017;390(10100):1211-59. https://doi.org/10.341 0/f.731220250.793569875 PMid:28919117

Stochkendahl MJ, Kjaer P, Hartvigsen J. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2018;27(1):60-75. PMid:28429142

Bardin LD, King P, Maher CG. Diagnostic triage for low back pain: A practical approach for primary care. Med J Aust. 2017;206(6):268-73. https://doi.org/10.5694/mja16.00828 PMid:28359011

Ashworth J, Konstantinou K, Dunn KM. Prognostic factors in non-surgically treated sciatica: A systematic review. BMC Musculoskelet Disord. 2011;12(1):208. https://doi. org/10.1186/1471-2474-12-208 PMid:21943339

Cook CE, Taylor J, Wright A, Milosavljevic S, Goode A, Whitford M. Risk factors for first time incidence sciatica: A systematic review. Physiother Res Int. 2014;19(2):65-78. https://doi.org/10.1002/pri.1572 PMid:24327326

Jacobs WC, Arts MP, Tulder MW. Surgical techniques for sciatica due to herniated disc, a systematic review. Eur Spine J. 2012;21(11):2232-51. https://doi.org/10.1016/j. spinee.2013.01.010 PMid:22814567

North American Spine Society. Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy. Burr Ridge, Illinois: North American Spine Society; 2012.

Weinstein JN, Lurie JD, Tosteson TD, Tosteson AN. Surgical versus non-operative treatment for lumbar disc herniation : Four-year results for the spine patient outcomes research trial (SPORT). Spine. 2009;33(25):2789-800. https://doi. org/10.1097/brs.0b013e31818ed8f4 PMid:19018250

Lurie J, Tosteson T, Tosteson A. Surgical versus non-operative treatment for lumbar disc herniation: eight-year results for the spine patient outcomes research trial (SPORT). Spine. 2014;39(1):3-16. https://doi.org/10.1097/ brs.0000000000000088 PMid:24153171

Shapiro CM. The failed back surgery syndrome: Pitfalls surrounding evaluation and treatment. Phys Med Rehabil Clin N Am. 2014;25(2):319-340. PMid:24787336

Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 2007;334(7607):1313-7. https://doi.org/10.1136/ bmj.39223.428495.be PMid:17585160

Lequin MB, Verbaan D, Jacobs WC. Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trial. BMJ Open. 2013;3(5):e002534. https://doi.org/10.1136/bmjopen-2012-002534

Sutheerayongprasert C, Paiboonsirijit S, Kuansongtham V, Anuraklekha S, Hiranyasthiti N, Neti S. Factors predicting failure of conservative treatment in lumbar-disc herniation. J Med Assoc Thai. 2012;95(5):674-80. PMid:22994027

Chien GC, Knezevic NN, McCormick Z, Chu SK, Trescot AM, Candido KD. Transforaminal versus interlaminar approaches to epidural steroid injections: A systematic review of comparative studies for lumbosacral radicular pain. Pain Phys. 2014;17(4):E509-24. https://doi.org/10.1016/j.pmrj.2013.08.016

Manchikanti L, Singh V, Pampati V, Falco FJ, Hirsch JA. Comparison of the efficacy of caudal, interlaminar, and transforaminal epidural injections in managing lumbar disc herniation: Is one method superior to the other? Korean J Pain. 2015;28(1):11-21. https://doi.org/10.3344/kjp.2015.28.1.11 PMid:25589942

Kim ES, Oladunjoye AO, Li JA, Kim KD. Spontaneous regression of herniated lumbar discs. J Clin Neurosci. 2014;21(6):909-13. https://doi.org/10.1016/j.jocn.2013.10.008

Lu HS, An SÖ, Murkaynak ET. Spontaneous regression of extruded lumbar disc herniation : Report of two illustrative case and review of the literature. Turk Neurosurg. 2008;18(4):392-6. PMid:19107686

Altun I, Yüksel KZ. Lumbar herniated disc: Spontaneous regression. Korean J Pain. 2017;30(1):44-50. https://doi. org/10.3344/kjp.2017.30.1.44 PMid:28119770

Kim SG, Yang JC, Kim TW, Park KH. Spontaneous regression of extruded lumbar disc herniation: three cases report. Korean J Spine. 2013;10(2):78-81. https://doi.org/10.14245/ kjs.2013.10.2.78 PMid:24757463

Macki M, Hernandez-Hermann M, Bydon M, Gokaslan A, McGovern K, Bydon A. Spontaneous regression of sequestrated lumbar disc herniations: Literature review. Clin Neurol Neurosurg. 2014;120:136-41. https://doi.org/10.1016/j. clineuro.2014.02.013 PMid:24630494

Manchikanti L, Benyamin RM, Falco FJ, Kaye AD, Hirsch JA. Do epidural injections provide short- and long-term relief for lumbar disc herniation? A systematic review. Clin Orthop Relat Res. 2015;473(6):1940-56. https://doi.org/10.1007/ s11999-014-3490-4 PMid:24515404

Bhatti AB, Kim S. Role of epidural injections to prevent surgical intervention in patients with chronic sciatica: A systematic review and meta-analysis. Cureus. 2016;8(8):e723. https://doi. org/10.7759/cureus.723 PMid:27625909

Risbud MV, Shapiro IM. Role of cytokines in intervertebral disc degeneration: Pain and disc-content. Nat Rev Rheumatol. 2015;10(1):44-56. https://doi.org/10.1038/nrrheum.2013.160 PMid:24166242

Guinto FC, Hashim H, Stumer M. CT Demonstration of disk regression after conservative therapy. AJNR Am J Neuroradiol. 1984;5:632-33. PMid:6435432

Chang CW, Lai PH, Yip CM, Hsu S.S. Spontaneous regression of lumbar herniated disc. J Chinese Med Assoc. 2009;72(12):650- 3. https://doi.org/10.1016/s1726-4901(09)70449-6 PMid:20028647

Tokmak M, Altiok IB, Guven M, Aras AB. Spontaneous regression of lumbar disc herniation after weight loss: Case report. Turk Neurosurg. 2015;25(4):657-61. PMid:26242347

Yang X, Zhang Q, Hao X, Guo X, Wang L. Spontaneous regression of herniated lumbar discs: Report of one illustrative case and review of the literature. Clin Neurol Neurosurg. 2016;143:86-9. https://doi.org/10.1016/j.clineuro.2016.02.020 PMid:26907997

Tarukado K, Ikuta K, Fukutoku Y, Tono O, Doi T. Spontaneous regression of posterior epidural migrated lumbar disc fragments: Case series. Spine J. 2015;15(6):e57-62. https://doi. org/10.1016/j.spinee.2013.07.430 PMid:24041917

Chiu CC, Chuang TY, Chang KH, Wu CH, Lin PW, Hsu WY. The probability of spontaneous regression of lumbar herniated disc: A systematic review. Clin Rehabil. 2015;29(2):184-95. https:// doi.org/10.1177/0269215514540919 PMid:25009200

Kato T, Haro H, Komori H, Shinomiya K. Sequential dynamics of inflammatory cytokine, angiogenesis inducing factor and matrix degrading enzymes during spontaneous resorption of the herniated disc. J Orthop Res. 2004;22(4):895-900. https:// doi.org/10.1016/j.orthres.2003.11.008 PMid:15183452

Lama P, Dolan P, Tarlton JF, Adams MA. Do intervertebral discs degenerate before they herniate, or after? Bone Joint J. 2013;95(8):1127-33. https://doi. org/10.1302/0301-620x.95b8.31660 PMid:23908431

Sun Z, Zhang M, Zhao XH. Immune cascades in human intervertebral disc: The pros and cons. Int J Clin Exp Pathol. 2013;6(6):1009-14. PMid:23696917

Haro H. Translational research of herniated discs: Current status of diagnosis and treatment. J Orthop Sci. 2014;19(4):515-20. PMid:24777237

Yoshida M, Nakamura T, Sei A, Kikuchi T, Takagi K, Matsukawa A. Intervertebral disc cells produce tumor necrosis factor alpha, interleukin-1beta, and monocyte chemoattractant protein-1 immediately after herniation: An experimental study using a new hernia model. Spine. 2005;30(1):55-61. https://doi. org/10.1097/01.brs.0000149194.17891.bf 36. Autio RA, Karppinen J, Niinima J, Vanharanta H, Tervonen O. Determinants of spontaneous resorption of intervertebral disc herniations. Spine. 2006;31(11):1247-52. https://doi. org/10.1097/01.brs.0000217681.83524.4a

el Barzouhi A., Vleggeert-Lankamp, C.L.A.M., Nijeholt, G.J. Magnetic resonance imaging in follow-up assessment of sciatica. N Engl J Med. 2013;368(11):999-1007. https://doi. org/10.1056/nejmoa1209250 PMid:23484826