Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis
Ming Zhong, MD, Jin Tao Liu, MD, Hong Jiang, MD, phD, Wen MO, PhD, Peng-Fei Yu, MD, Xiao Chun Li, MD, and Rui Rui Xue, MD
Pain Physician 2017; 20:E45-E52
Key points:
1. Studies of acute Lumbar Disc Herniation (LDH) have found that 2 and 5 years after diagnosis there was little difference between patients who underwent surgery and those who did not.
2. Since 1990 magnetic resonance imaging (MRI) and computed tomography (CT) have provide evidence that conservative treatment allows resorption of the herniated disc.
3. …the overall incidence of spontaneous resorption after LDH was 66.66% ….
4. Spontaneous regression of disc herniation at repeat epidurography has been described since 1945.
5. IN 1990, an article was published in Spine in which Saal et al first identified the phenomenon of spontaneous resorption as observed by MRI and CT. This phenomenon showed us that LDH could be treated conservatively.
6. Overall incidence of LDH reabsorption was around 66.66%. In japan, the resorption rate was 62.58%, which is close to the average level.
7. In the United Kingdom, the incidence was much higher, at 82.94%.
Dr. Wu DC comment:
• This is a really good review article for people who are suffering from the lumbar disc herniation (LDH). LDH can cause debilitating discomforts such as leg weakness, nerve pain shoots down the leg to even affected organs functions. However, LDH could also be incidental finding which means it is completely asymptotic and benign.
• The conventional treatment for LDH is usually operation/surgery, but as this article stated, the surgical outcome is not much different from conservative treatment.
• The conservative treatments in this paper includes: bed rest, oral steroids, NASIDS, massage, physical therapy; and may I add the specific chiropractic adjustment to the list as multiple other studies have shown.
• It is also interesting to see the age demographic in this article, as it ranges from 20s to 80s. In other words, the body is always attempting to heal itself as long as we provide a good environment to allow it to do so, in regardless to the age.
• I have always remembered what my professor told us in the class: if you have a hammer in your hand, everything looks like a nail. If you have a symptomatic disc herniation, depends on whom you talk to first, could very well decided ending up on the operation table or not. Surgery or conservative treatment, the decision is yours, but I know which one I am going to choose first.
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