Delayed Spontaneous Resorption of Lumbar Intervertebral Disc Herniation: A Case Report.

ABSTRACT

Background • Large intervertebral disc herniation is often managed with surgery, but it is not uncommon for spontaneous resorption of herniated disc material to occur. Although the majority of spontaneous disc resorption occurs in the acute phase, an unusual case of delayed intervertebral disc regression at 18 mo postonset is presented. Case Presentation • A 32-y-old female patient presented with acute low-back pain and pain in both legs a Korean medicine hospital specializing in spinal disorders. Massive intervertebral disc herniation was found on lumbar magnetic resonance imaging (MRI), and inguinal and genital pain and numbness was suggestive of risk of cauda equina syndrome. Although she was recommended for surgery, the patient steadfastly refused surgical intervention and continued to receive nonsurgical Korean medicine treatment. Imaging studies including computed tomography scans and MRIs were taken in consideration of possible spontaneous disc regression at 3 and 6 mo, and 1 y after onset of symptoms with no initial disc resorption. However, delayed spontaneous regression of most of the herniated disc material was observed at 18 mo, and the majority of pain symptoms and functional disability recovered up to 2 y postonset. Conclusions • Delayed intervertebral disc resorption was observed in a case of large disc herniation well past the acute phase, and there was noticeable time difference in resolution on MRI and subsequent improvement in pain and functional recovery.