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| Year : 1999 | Volume
: 47
| Issue : 4 | Page : 338-9 |
Spontaneous resorption of extruded lumber disc fragment.
Singh P, Singh A
How to cite this article:
Singh P, Singh A. Spontaneous resorption of extruded lumber disc fragment. Neurol India 1999;47:338 |
Since the time Mixter and Barr first established the entity of prolapsed lumbar disc and its surgical treatment in 1934,[1] increasing number of patients are being subjected to surgery and minimally invasive procedure of percutaneous lumbar discectomy. However, many of these patients improve with conservative treatment and this makes the decision to operate difficult, despite the exhaustive list of criteria evolved over the years.[2] Even magnetic resonance imaging may not help in making correct decision. We are reporting a case of extruded prolapsed lumbar disc, who was treated conservatively by providence and the extruded fragment was totally resorbed.
A 43 year old man developed low backache and right sided sciatica following lifting of heavy weight in June 98. He was treated with rest and analgesics but had little relief. Clinically, he had paraspinal spasm in the lumbar region restricted straight leg raising test on right side and positive Lasegue's test. There was no other neurological deficit. MRI of lumbar spine revealed a degenerated L3/4 disc with a large extruded fragment lying behind L3 vertebral body [Figure. 1]. He was offered surgery by the treating doctor, but he refused. Gradually his pain started receding but MRI abnormality caused lot of worry. He came to us to get operated in Nov 98 and was totally asymptomatic by then. Evaluation revealed normal lumbar spine, 90 degree straight leg raising, minimal wasting of right thigh (3 cms), normal power, no sensory deficit and normal reflexes. A repeat MRI of lumbar spine revealed complete resorption of extruded fragment of L3/4 disc [Figure. 2] and hence no surgery was offered.
Recovery from sciatica was well known long before its cause was known and diverse therapeutic modalities were in practice such as blood letting, purging, sealding etc. The role of surgery was correctly put in place by Mixter and Barr.[1] The role of conservative treatment and surgery is well defined today.[2] However, intervertebral disc disease still holds many mysteries, one of which is seen in the present case; an extruded fragment of prolapsed intervertebral disc as seen on MRI, completely resorbed spontaneously as confirmed on MRI done 4 months later. There was resolution of backache and sciatica. MRI thus provides an unique opportunity to study the natural history of disc prolapse in patients not subjected to surgery. Resorption of disc material, that had extruded probably occurs due to dehydration, maceration and phagocytosis. The role of compression in a tight epidural space is speculative.[3],[4] Whether these natural processess can be augmented is a thing for the future. At the moment this case throws enough light that even a patient with extruded disc fragment as seen on MRI can be treated conservatively, provided he is improving and does not have significant neurological deficit.
| 1. | Mixter WI, Barr JS : Rupture of the intervertebral disc with involvement of spinal canal. N Eng J Med 1934; 211 : 210-215.  |
| 2. | Finneson BE : Lumbar disc excision. In Operative Neurosurgical Techniques. Eds. Schmidek HH and Sweet WH. WB Saunders Company, London. 1995; 2 : 195-1923. |
| 3. | Bazzao A, Gallucci M, Masciocehi C et al : Lumbar disc herniation : MR imaging assessment of natural history in patient treated without surgery. Radiology 1992; 185 : 135-141. |
| 4. | Fager CA : Observations on spontaneous recovery from intervertebral disc herniation. Surg Neurol 1994; 42 : 282-286. |
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