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| GRANDE HÉRNIA DE DISCO ANTES |
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| DESAPARECIMENTO DE HERNIA APÓS 6 MESES |
Diversos trabalhos científicos mostram que este fato é muito mais comum do que se pensava. Desta forma, nos últimos tempos, as cirugias de hérnias passaram a ter indicações muito mais restritas, sendo corretamente indicada apenas na síndrome da cauda equina, nas mielopatias e nas paralisias resistentes ao tratamento conservador. Dores não são indicações de cirurgias, pois os modernos tratamentos farmacológicos infiltrativos conseguem um controle excelente. Processos sérios envolvem medicação de qualidade e Fisioterapia para recuperação funcional.
Veja resumos de trabalhos abaixo:
Minim Invasive Neurosurg. 2004 Aug;47(4):226-9.
Spontaneous resolution of "protruded" lumbar discs.
Source
Department of Neurosurgery, Kirikkale University Medical School, Kirikkale, Turkey. sk06-k@tr.netAbstract
Decreasing size of disc material that has herniated, whether "contained" or "protruded" has previously been described and sometimes this can be so complete that residual material is barely visible. In a retrospective clinical survey, from among almost 2180 consecutive patients admitted during 1994 - 2002 with low back pain; due to our low follow-up ratios and high price of the magnetic resonance imaging (MRI), only 42 patients with a lumbar disc protrusion could be found who had two MRI scans obtained at least five weeks apart. Among these, 4 patients were spotted with a totally resolved disc protrusion. T (2)-weighted MRI images were suggesting shrinkage due to dehydration and regression within the annulus of protruded disc fragments that had not fully migrated. Our patients are further examples for total resolution of the large "protruded" disc without any treatment; and since concomitant disc protrusions at other levels persisted, the resolution of these discs is supposed to be spontaneous.
Arch Phys Med Rehabil. 1989 Nov;70(12):842-4.
Regression of herniated nucleus pulposus: two patients with lumbar radiculopathy.
Source
Department of Rehabilitation Medicine, Sinai Hospital, Detroit, MI 48235.Abstract
Thirty percent to 95% of patients with lumbar radiculopathy secondary to a bulging or herniated disc improve to a pain-free and functional level with nonsurgical treatment. What happens to the herniated disc material as this improvement occurs is unclear. We present two patients with lumbar radiculopathy documented by physical examination and electrodiagnostic testing. Both patients had herniated disc material at the L5 to S1 level on computed tomography (CT) scans corresponding to the side and level of their lesion on physical examination and electrodiagnostic testing. In both instances, the radiculopathy resolved with conservative treatment. CT scans were repeated in three months on one patient and four months on the other. The scans showed major resolution of the herniated disc material in both patients. These two cases demonstrate that in some patients with proven radiculopathy secondary to herniated nucleus pulposus, the herniated disc material will no longer be visible on CT scan and is presumed to resorb as the symptoms abate.
Neurocirugia (Astur). 2007 Apr;18(2):138-40.
[Spontaneous resolution of a lumbar disc herniation].
[Article in Spanish]
Source
Servicios de Neurocirugía, Hospital Clínico de Santiago Lugo, Departamento de Cirugía, Universidad de Santiago de Compostela.Abstract
Lumbar disc herniation is a common cause of lower leg radiculopathy and the most effective methods of treatment remain in question. Both surgical and nonsurgical treatments may provide a successful outcome in appropriately selected patients. The spontaneous resolution of herniated lumbar discs is a well-established phenomenon. The authors present a case of spontaneous regression of a herniated lumbar nucleus pulpous in a patient with radiculopathy.
J Med Invest. 2002 Feb;49(1-2):40-3.
Natural history of extruded lumbar intervertebral disc herniation.
Source
Department of Orthopedic Surgery, Health Insurance Naruto Hospital, Muya-cho, Naruto, Tokushima 772-8503, Japan.Abstract
We studied the natural history of extruded lumbar intervertebral discs using MRI. Forty-nine patients with lumbar disc herniation were included in this study. Ages ranged from 19 to 57. On the T2-weighted sagittal MR image, the signal intensity in the herniated mass was measured and the ratio to that in the original nucleus (i.e., nucleus pulposus from which they extruded) was calculated (signal intensity ratio; SIR). The relationship with SIR and duration of illness was evaluated. In ten patients who were re-examined by MRI after conservative treatment, the size of the herniation measured by T1-weighted axial MR image was compared before and after treatment. The signal intensity of HNP became higher than that of the original nucleus immediately following herniation and thereafter decreased with time, suggesting that initial hydration of the HNP occurred shortly after herniation followed by dehydration of the HNP. The size of the HNP with a SIR value of 1.2 and higher on T2-weighted MR images decrease with time, however, the HNP with a SIR below 1.2 did not show any size reduction. The SIR of 1.2 and higher is a good indicator predicting spontaneous reduction of the HNP. Dehydration in the HNP may play an important role in the reduction of the lumbar disc herniation.
J Chin Med Assoc. 2009 Dec;72(12):650-3. doi: 10.1016/S1726-4901(09)70449-6.
Spontaneous regression of lumbar herniated disc.
Source
Division of Neurosurgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.Abstract
Intervertebral disc herniation of the lumbar spine is a common disease presenting with low back pain and involving nerve root radiculopathy. Some neurological symptoms in the majority of patients frequently improve after a period of conservative treatment. This has been regarded as the result of a decrease of pressure exerted from the herniated disc on neighboring neurostructures and a gradual regression of inflammation. Recently, with advances in magnetic resonance imaging, many reports have demonstrated that the herniated disc has the potential for spontaneous regression. Regression coincided with the improvement of associated symptoms. However, the exact regression mechanism remains unclear. Here, we present 2 cases of lumbar intervertebral disc herniation with spontaneous regression. We review the literature and discuss the possible mechanisms, the precipitating factors of spontaneous disc regression and the proper timing of surgical intervention.
Acta Neurochir (Wien). 2009 Oct;151(10):1299-300. doi: 10.1007/s00701-009-0370-x.
Spontaneous regression of a huge subligamentous extruded disc herniation: short report of an illustrative case.
Source
Department of Neurosurgery, Abant Izzet Baysal University, Bolu, Turkey.Abstract
Herniated nucleus pulposus (HNP) is a common cause of radicular and low-back pain. Although some patients need surgical intervention because of prolonged intolerable leg pain, the majority heal with conservative treatment. Recently, with the advent of imaging diagnostic methods, there is an increasing interest in the phenomenon of spontaneous resorption of the HNP. We presented a case of lumbar HNP at the L4-L5 level in which clinical improvement was associated with a significant decrease in size of a huge subligamentous extruded disc herniation, documented on serial magnetic resonance imaging (MRI) scans.
Spine (Phila Pa 1976). 1996 Jan 15;21(2):225-9.
The natural history of herniated nucleus pulposus with radiculopathy.
Source
Department of Orthopedic Surgery, Tokyo Medical and Dental University, Japan.Abstract
STUDY DESIGN:
The present study retrospectively investigated the morphologic changes that occurred during conservative treatment of patients with unilateral leg pain resulting from herniated nucleus pulposus without significant lumbar canal stenosis.OBJECTIVES:
The results were correlated with clinical outcomes and extruding forms to determine which type of herniated nucleus pulposus had the greatest capacity for spontaneous regression and how rapidly such regression might occur.SUMMARY OF BACKGROUND DATA:
The study population consisted of 77 patients with radiculopathy.METHODS:
All patients complained primarily of unilateral leg pain, and 94% had positive tension signs. Additionally, 32% exhibited muscle weakness corresponding to the symptomatic nerve root. All patients were studied more than twice using magnetic resonance imaging during conservative therapy at a mean interval of 150 days. Morphologic changes on magnetic resonance imaging fell into four categories, with herniated nucleus pulposus classified into three types using T1-weighted sagittal views. Each patient was reexamined on the same scanner; 53 patients were examined twice, and 24 patients were examined more than three times.RESULTS:
Morphologic changes, with the exception of 13 false-negative cases, basically corresponded to clinical outcome. In half of the cases that showed some improvement at follow-up evaluation, improvement of clinical findings were seen before those observed on magnetic resonance imaging. Migrating herniated nucleus pulposus frequently presented an obvious decrease in size, and even disappearance in seven cases. The further the herniated nucleus pulposus migrated, the more decrease in size could be observed. The cases apparently corresponding to "protrusion" showed little or no change on follow-up magnetic resonance imaging. Regarding the mechanism of herniated nucleus pulposus disappearance, exposure to the vascular supply undoubtedly took a part, although many factors were suspected to have some influence.CONCLUSION:
Morphologic changes on magnetic resonance imaging mainly corresponded to clinical outcomes but tended to lag behind improvement of leg pain. Disappearance of herniate nucleus pulposus was seen frequently in the cases of migrating disc herniation, and it was presumed that exposure to the vascular supply had a lot to do with this phenomenon.
Turk Neurosurg. 2008 Oct;18(4):392-6.
Spontaneous regression of extruded lumbar disc herniation: report of two illustrative case and review of the literature.
Source
Ufuk University School of Medicine, Departmert of Neurosurgery, Ankara, Turkey. hsabuncuoglu@hotmail.comAbstract
Although the first reported surgery for lumbar disc herniation was published many years ago, there still remains little agreement for the most effective treatment protocol for symptomatic cases. Many patients with extruded lumbar disc herniation require surgical intervention due to radiculopathy of lower extremities but some neurological symptoms of intervertebral disc herniation may frequently improve with conservative treatment. In this paper, two cases of spontaneous regression of extruded lumbar herniated discs are presented. The disc regressions of two patients were correlated with clinical improvement and documented with follow up MRI studies. Additionally the clinical course of lumbar disc herniation was discussed with mechanisms, features of MRI, immunohistological pathology and treatment options of past clinical studies.
Joint Bone Spine. 2002 Mar;69(2):155-60.
The natural history of lumbar disc herniation and radiculopathy.
Abstract
The majority of patients suffering from a radiculopathy caused by a herniated nucleus pulposus (HNP) heal spontaneously without surgery or chemonucleolysis. The clinical course of the radiculopathy varies as well as the efficacy of conservative treatment. In some patients the symptoms decline after a week or two; in others the pain may continue for many months or years. Despite an abundant literature there is still a controversy concerning the treatment of radiculopathies related to ruptured lumbar intervertebral discs. Obviously knowledge of the natural history of discal herniation, and of the mechanisms leading to the changes of the extruded discal tissue, would be of great help in planning the therapeutic procedure. The purpose of this article is to review the reliable data concerning the clinical and pathomorphological evolution and the biological mechanisms associated with the morphologic changes of discal herniation.
Spine (Phila Pa 1976). 2002 Mar 1;27(5):549-53.
Multiple independent, sequential, and spontaneously resolving lumbar intervertebral disc herniations: a case report.
Source
Dartmouth Medical School, Hanover New Hampshire, USA. William.a.abdu@hitchcock.orgAbstract
STUDY DESIGN:
A case report is presented.OBJECTIVE:
To highlight the potential for spontaneous resolution of large extruded intervertebral lumbar disc herniations in a patient with three independent herniations.SUMMARY OF BACKGROUND DATA:
The most effective methods of treatment for lumbar intervertebral disc herniations remain in question. This is partly because the potential for intrinsic spontaneous resolution is not understood, and because many believe that large extruded lumbar intervertebral disc herniations require surgical intervention. This case report addresses both issues.METHODS:
A case is reported and the literature is reviewed.RESULTS:
In the patient described, multiple independent lumbar intervertebral disc herniations resolved spontaneously both clinically and radiographically with nonoperative treatment.CONCLUSIONS:
Not only is the question concerning the cause of disc herniation unresolved, but the best methods of treatment also are generally unclear. This case report documents a patient with the intrinsic capability not only to herniate multiple lumbar intervertebral discs, but also to resolve them clinically and anatomically. Extruded lumbar intervertebral disc herniations may be treated without surgery, as highlighted by this case report. The immunohistologic pathomechanism for resorption remains unclear.
Spine (Phila Pa 1976). 1996 Dec 15;21(24 Suppl):2S-9S.
Natural history and nonoperative treatment of lumbar disc herniation.
Source
SOAR, Physiatry Medical Group, Menlo Park, California, USA.Abstract
Lumbar disc herniation is a common condition with a favorable prognosis in the majority of circumstances. This article reviews the published scientific evidence regarding the impact of nonoperative care on this condition. The published studies are critiqued and evaluated on their relative strengths and weaknesses. The effect of time, medications, exercise, injection therapy, and manipulation are considered. The literature regarding the natural history process of disc resorption is reviewed, including time frames and the proposed underlying mechanisms that may enhance or impede this process. The effect of inflammation on treatment effectiveness and decision-making is evaluated. The possible impact of various types and locations of lumbar disc herniation, coexisting anatomic factors, lumbar disc herniation material type, lumbar disc herniation material chemical factors, clinical characteristics, and patient-related factors are discussed. Appropriate candidates for operative versus nonoperative care are discussed. Conclusions are drawn from this literature review that will help guide management decisions.
J Spinal Disord Tech. 2005 Apr;18(2):121-6.
Natural history of patients with lumbar disc herniation observed by magnetic resonance imaging for minimum 7 years.
Source
Department of Orthopedic Surgery, Nagoya University School of Medicine, Nagoya, Japan. tm1998@qc4.so-net.ne.jpAbstract
OBJECTIVE:
The aim of this work was to elucidate the relation between the clinical course and morphologic changes of lumbar disc herniation on magnetic resonance imaging (MRI).METHODS:
Twenty-one patients with lumbar disc herniation treated nonsurgically were followed for a minimum of 7 years and investigated with regard to their clinical outcome and the initial, 2-year, and final stage MRI findings. The space-occupying ratio of herniation to the spinal canal and the degree of disc degeneration were evaluated on serial MRI.RESULTS:
The mean space-occupying ratio of herniation showed significant reduction both on the 2-year and on the final scans. Progression of degeneration of the intervertebral disc was seen in all patients at the final investigation. Comparing patients with and without symptoms, no factors were detected on the initial and 2-year MR images capable of distinguishing patients who were and were not destined to develop lumbago and/or sciatica in the future. Morphologic changes of lumbar disc herniation continued to occur even after 2 years.CONCLUSIONS:
Clinical outcome did not depend on the size of herniation or the grade of degeneration of the intervertebral disc in the minimum 7-year follow-up.
J Radiol. 1989 Dec;70(12):697-702.
[Spontaneous regression of disk herniation. Apropos of 7 cases].
[Article in French]
Source
Praticien Hospitalier Service de médecine, Brive.Abstract
The author report 5 cases of lumbar radiculopathy and 2 cases of low-back pain with disc herniation in which a CT Scan shows spontaneous disappearing or regression of disc herniation. This spontaneous regression is especially observed in young patients on average: 18 to 19 months. His mechanism is discussed.
Br J Gen Pract. 2008 Sep;58(554):646-7. doi: 10.3399/bjgp08X341968.
Spontaneously disappearing lumbar disc protrusion.
Source
Department of Neurosurgery, University Hospital of Coventry and Warwickshire, Coventry.Abstract
Spontaneous disappearance of a herniated lumbar disc is known to occur. This case study describes a 45-year-old patient whose symptoms of lumbar radiculopathy resolved and follow-up imaging showed complete disappearance of the disc prolapse. This phenomenon strengthens the role of conservative treatment in the management of lumbar disc protrusions
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