Research progress of resorption of lumbar disc herniation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Daoguang , BAI Yuncheng , ZHANG Guoqi , CHEN Lilong , XU Weipeng ,  LIU Jie

Department of Orthopaedics, the Affiliated Hospital of Kunming University of Science and Technology, the First People’s Hospital of Yunnan Province, Kunming Yunnan, 650034, P. R. China;

Corresponding author：

LIU Jie, Email: pacemakerliu@126.com

Keywords：

Lumbar disc herniation; resorption; conservative treatment; surgery treatment

DOI：

10.7507/1002-1892.202204105

Video：

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Objective To summarize the research progress of resorption of lumbar disc herniation (RLDH). Methods The literature on RLDH at home and abroad in recent years was reviewed to summarize its influencing factors, pathogenesis, imaging findings, and predictive effect, as well as its influence on the treatment selection of lumbar disc herniation (LDH). Results The main mechanism of RLDH is the combined effect of inflammatory response and neovascularization. Age, smoking, body mass index, and clinical manifestations are the influencing factors. Studies have shown that the annular enhancement around the nucleus pulposus on enhanced MRI images is the characteristic imaging manifestation of RLDH, which is a predictor of whether RLDH occurs. In the treatment of LDH, cyclooxygenase 2 inhibitors may have a negative impact on RLDH. Conclusion The occurrence of RLDH suggests that strict conservative treatment is the first choice for LDH treatment, but surgery is still an important treatment method when the patient’s symptoms and imaging symptoms don’t significantly improved after conservative treatment.

Citation： LIU Daoguang, BAI Yuncheng, ZHANG Guoqi, CHEN Lilong, XU Weipeng, LIU Jie. Research progress of resorption of lumbar disc herniation. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(10): 1312-1316. doi: 10.7507/1002-1892.202204105 Copy

1.	Reuschel V, Scherlach C, Pfeifle C, et al. Treatment effect of CT-guided periradicular injections in context of different contrast agent distribution patterns. Diagnostics (Basel), 2022, 12(4): 787. doi: 10.3390/diagnostics12040787.
2.	Kuchekar PG. Study of spontaneous resorption of lumbar disc herniation, in females of Maharashtra. International Journal of Contemporary Surgery, 2018, 6(1): 92-94.
3.	Jung YJ, Shin JS, Lee J, et al. Delayed spontaneous resorption of lumbar intervertebral disc herniation: A case report. Altern Ther Health Med, 2017, 23(7): 58-63.
4.	Kesikburun B, Eksioglu E, Turan A, et al. Spontaneous regression of extruded lumbar disc herniation: Correlation with clinical outcome. Pak J Med Sci, 2019, 35(4): 974-980.
5.	Guinto FC Jr, Hashim H, Stumer M. CT demonstration of disk regression after conservative therapy. AJNR Am J Neuroradiol, 1984, 5(5): 632-633.
6.	Wang R, Luo H. Regression of lumbar disc herniation with non-surgical treatment: a case report. J Int Med Res, 2021, 49(6): 3000605211020636. doi: 10.1177/03000605211020636.
7.	de David CN, Deligne LMC, da Silva RS, et al. The burden of low back pain in Brazil: estimates from the Global Burden of Disease 2017 Study. Popul Health Metr, 2020, 18(Suppl 1): 12. doi: 10.1186/s12963-020-00205-4.
8.	Fagerlund MK, Thelander U, Friberg S. Size of lumbar disc hernias measured using computed tomography and related to sciatic symptoms. Acta Radiol, 1990, 31(6): 555-558.
9.	Chiu CC, Chuang TY, Chang KH, et al. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil, 2015, 29(2): 184-195.
10.	Ahn SH, Ahn MW, Byun WM. Effect of the transligamentous extension of lumbar disc herniations on their regression and the clinical outcome of sciatica. Spine (Phila Pa 1976), 2000, 25(4): 475-480.
11.	Kawaguchi K, Harimaya K, Matsumoto Y, et al. Effect of cartilaginous endplates on extruded disc resorption in lumbar disc herniation. PLoS One, 2018, 13(4): e0195946. doi: 10.1371/journal.pone.0195946.
12.	Oktay K, Ozsoy KM, Dere UA, et al. Spontaneous regression of lumbar disc herniations: A retrospective analysis of 5 patients. Niger J Clin Pract, 2019, 22(12): 1785-1789.
13.	刁志君, 姜宏, 刘锦涛. 细胞自噬对腰椎间盘突出后重吸收的意义. 中国骨伤, 2019, 22(12): 1785-1789.
14.	Turk O, Antar V, Yaldiz C. Spontaneous regression of herniated nucleus pulposus: The clinical findings of 76 patients. Medicine (Baltimore), 2019, 98(8): e14667. doi: 10.1097/MD.0000000000014667.
15.	Çitişli V, İbrahimoğlu M. Spontaneous remission of a big subligamentous extruded disc herniation: case report and review of the literature. Korean J Spine, 2015, 12(1): 19-21.
16.	Orief T, Orz Y, Attia W, et al. Spontaneous resorption of sequestrated intervertebral disc herniation. World Neurosurg, 2012, 77(1): 146-152.
17.	俞鹏飞, 刘锦涛, 马智佳, 等. 破裂型腰椎间盘突出症转归预测因素的Logistic回归分析. 中国骨伤, 2018, 31(6): 522-527.
18.	Tokmak M, Altiok IB, Guven M, et al. Spontaneous regression of lumbar disc herniation after weight loss: Case report. Turk Neurosurg, 2015, 25(4): 657-661.
19.	Kim YH, Lee JY, Kim KH, et al. Comparative analysis on disc resorption rate of lumbar disc herniation patients after Korean medicine treatment and predictive factors associated with disc resorption. Journal of Korean Medicine Rehabilitation, 2018, 28(4): 33-41.
20.	Tsarouhas A, Soufla G, Katonis P, et al. Transcript levels of major MMPs and ADAMTS-4 in relation to the clinicopathological profile of patients with lumbar disc herniation. Eur Spine J, 2011, 20(5): 781-790.
21.	Ostafiński K, Świątnicki W, Szymański J, et al. Predicting conservative treatment failure in patients with lumbar disc herniation. Single center, case-control study. Clin Neurol Neurosurg, 2020, 193: 105867. doi: 10.1016/j.clineuro.2020.105867.
22.	Vroomen PC, de Krom MC, Knottnerus JA. Predicting the outcome of sciatica at short-term follow-up. Br J Gen Pract, 2002, 52(475): 119-123.
23.	Mochida K, Komori H, Okawa A, et al. Regression of cervical disc herniation observed on magnetic resonance images. Spine (Phila Pa 1976), 1998, 23(9): 990-997.
24.	Rätsep T, Minajeva A, Asser T. Relationship between neovascularization and degenerative changes in herniated lumbar intervertebral discs. Eur Spine J, 2013, 22(11): 2474-2480.
25.	Arai Y, Yasuma T, Shitoto K, et al. Immunohistological study of intervertebral disc herniation of lumbar spine. J Orthop Sci, 2000, 5(3): 229-231.
26.	Borota L, Jonasson P, Agolli A. Spontaneous resorption of intradural lumbar disc fragments. Spine J, 2008, 8(2): 397-403.
27.	Morozumi N, Aizawa T, Sasaki M, et al. Spontaneous resorption of intradural lumbar disc herniation: A rare case report. Spine Surg Relat Res, 2019, 4(3): 277-279.
28.	Haro H, Nishiga M, Ishii D, et al. Experimental chemonucleolysis with recombinant human matrix metalloproteinase 7 in human herniated discs and dogs. Spine J, 2014, 14(7): 1280-1290.
29.	Hatano E, Fujita T, Ueda Y, et al. Expression of ADAMTS-4 (aggrecanase-1) and possible involvement in regression of lumbar disc herniation. Spine (Phila Pa 1976), 2006, 31(13): 1426-1432.
30.	Haro H, Shinomiya K, Komori H, et al. Upregulated expression of chemokines in herniated nucleus pulposus resorption. Spine (Phila Pa 1976), 1996, 21(14): 1647-1652.
31.	Park JB, Chang H, Kim KW. Expression of Fas ligand and apoptosis of disc cells in herniated lumbar disc tissue. Spine (Phila Pa 1976), 2001, 26(6): 618-621.
32.	Wang Z, Wang G, Zhu X, et al. Interleukin-2 is upregulated in patients with a prolapsed lumbar intervertebral disc and modulates cell proliferation, apoptosis and extracellular matrix metabolism of human nucleus pulposus cells. Exp Ther Med, 2015, 10(6): 2437-2443.
33.	Ha KY, Koh IJ, Kirpalani PA, et al. The expression of hypoxia inducible factor-1alpha and apoptosis in herniated discs. Spine (Phila Pa 1976), 2006, 31(12): 1309-1313.
34.	刘锦涛, 姜宏, 王拥军, 等. 大鼠破裂型椎间盘突出模型的建立及突出物重吸收机制的研究. 中国骨伤, 2006, 31(12): 1309-1313.
35.	Iwabuchi M, Murakami K, Ara F, et al. The predictive factors for the resorption of a lumbar disc herniation on plain MRI. Fukushima J Med Sci, 2010, 56(2): 91-97.
36.	Yamashita K, Hiroshima K, Kurata A. Gadolinium-DTPA—enhanced magnetic resonance imaging of a sequestered lumbar intervertebral disc and its correlation with pathologic findings. Spine (Phila Pa 1976), 1994, 19(4): 479-482.
37.	Ma Z, Yu P, Jiang H, et al. Conservative treatment for giant lumbar disc herniation: Clinical study in 409 cases. Pain Physician, 2021, 24(5): E639-E648.
38.	Djuric N, Yang X, Barzouhi AE, et al. Gadolinium enhancement is not associated with disc inflammation in patients with sciatica. Spine (Phila Pa 1976), 2019, 44(12): E742-E748.
39.	Ramos Amador A, Alcaraz Mexía M, González Preciado JL, et al. Natural history of lumbar disc hernias: does gadolinium enhancement have any prognostic value? Radiologia, 2013, 55(5): 398-407.
40.	Sinnecker T, Bozin I, Dörr J, et al. Periventricular venous density in multiple sclerosis is inversely associated with T2 lesion count: a7 Tesla MRI study. Mult Scler, 2013, 19(3): 316-325.
41.	Demirel A, Yorubulut M, Ergun N. Regression of lumbar disc herniation by physiotherapy. Does non-surgical spinal decompression therapy make a difference? Double-blind randomized controlled trial. J Back Musculoskelet Rehabil, 2017, 30(5): 1015-1022.
42.	Buttermann GR. Lumbar disc herniation regression after successful epidural steroid injection. J Spinal Disord Tech, 2002, 15(6): 469-476.
43.	Haro H, Domoto T, Maekawa S, et al. Resorption of thoracic disc herniation. Report of 2 cases. J Neurosurg Spine, 2008, 8(3): 300-304.
44.	Hong SJ, Kim DY, Kim H, et al. Resorption of massive lumbar disc herniation on MRI treated with epidural steroid injection: A retrospective study of 28 cases. Pain Physician, 2016, 19(6): 381-388.
45.	Aydin MV, Sen O, Kayaselcuk F, et al. Analysis and prevalence of inflammatory cells in subtypes of lumbar disc herniations under cyclooxygenase-2 inhibitor therapy. Neurol Res, 2005, 27(6): 609-612.
46.	苏彩风. COX-2抑制剂对腰椎间盘突出影响的实验研究. 武汉: 华中科技大学, 2008.
47.	Sucuoğlu H, Barut AY. Clinical and radiological follow-up results of patients with sequestered lumbar disc herniation: A prospective cohort study. Med Princ Pract, 2021, 30(3): 244-252.
48.	Overdevest GM, Vleggeert-Lankamp CL, Jacobs WC, et al. Recovery of motor deficit accompanying sciatica-subgroup analysis of a randomized controlled trial. Spine J, 2014, 14(9): 1817-1824.
49.	Jha V, Deep G, Pandita N, et al. Factors affecting urinary outcome after delayed decompression in complete cauda equina syndrome: “A regression model study”. Eur J Trauma Emerg Surg, 2022, 48(2): 1009-1016.
50.	Tarukado K, Ikuta K, Fukutoku Y, et al. Spontaneous regression of posterior epidural migrated lumbar disc fragments: case series. Spine J, 2015, 15(6): e57-e62.

1. Reuschel V, Scherlach C, Pfeifle C, et al. Treatment effect of CT-guided periradicular injections in context of different contrast agent distribution patterns. Diagnostics (Basel), 2022, 12(4): 787. doi: 10.3390/diagnostics12040787.
2. Kuchekar PG. Study of spontaneous resorption of lumbar disc herniation, in females of Maharashtra. International Journal of Contemporary Surgery, 2018, 6(1): 92-94.
3. Jung YJ, Shin JS, Lee J, et al. Delayed spontaneous resorption of lumbar intervertebral disc herniation: A case report. Altern Ther Health Med, 2017, 23(7): 58-63.
4. Kesikburun B, Eksioglu E, Turan A, et al. Spontaneous regression of extruded lumbar disc herniation: Correlation with clinical outcome. Pak J Med Sci, 2019, 35(4): 974-980.
5. Guinto FC Jr, Hashim H, Stumer M. CT demonstration of disk regression after conservative therapy. AJNR Am J Neuroradiol, 1984, 5(5): 632-633.
6. Wang R, Luo H. Regression of lumbar disc herniation with non-surgical treatment: a case report. J Int Med Res, 2021, 49(6): 3000605211020636. doi: 10.1177/03000605211020636.
7. de David CN, Deligne LMC, da Silva RS, et al. The burden of low back pain in Brazil: estimates from the Global Burden of Disease 2017 Study. Popul Health Metr, 2020, 18(Suppl 1): 12. doi: 10.1186/s12963-020-00205-4.
8. Fagerlund MK, Thelander U, Friberg S. Size of lumbar disc hernias measured using computed tomography and related to sciatic symptoms. Acta Radiol, 1990, 31(6): 555-558.
9. Chiu CC, Chuang TY, Chang KH, et al. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil, 2015, 29(2): 184-195.
10. Ahn SH, Ahn MW, Byun WM. Effect of the transligamentous extension of lumbar disc herniations on their regression and the clinical outcome of sciatica. Spine (Phila Pa 1976), 2000, 25(4): 475-480.
11. Kawaguchi K, Harimaya K, Matsumoto Y, et al. Effect of cartilaginous endplates on extruded disc resorption in lumbar disc herniation. PLoS One, 2018, 13(4): e0195946. doi: 10.1371/journal.pone.0195946.
12. Oktay K, Ozsoy KM, Dere UA, et al. Spontaneous regression of lumbar disc herniations: A retrospective analysis of 5 patients. Niger J Clin Pract, 2019, 22(12): 1785-1789.
13. 刁志君, 姜宏, 刘锦涛. 细胞自噬对腰椎间盘突出后重吸收的意义. 中国骨伤, 2019, 22(12): 1785-1789.
14. Turk O, Antar V, Yaldiz C. Spontaneous regression of herniated nucleus pulposus: The clinical findings of 76 patients. Medicine (Baltimore), 2019, 98(8): e14667. doi: 10.1097/MD.0000000000014667.
15. Çitişli V, İbrahimoğlu M. Spontaneous remission of a big subligamentous extruded disc herniation: case report and review of the literature. Korean J Spine, 2015, 12(1): 19-21.
16. Orief T, Orz Y, Attia W, et al. Spontaneous resorption of sequestrated intervertebral disc herniation. World Neurosurg, 2012, 77(1): 146-152.
17. 俞鹏飞, 刘锦涛, 马智佳, 等. 破裂型腰椎间盘突出症转归预测因素的Logistic回归分析. 中国骨伤, 2018, 31(6): 522-527.
18. Tokmak M, Altiok IB, Guven M, et al. Spontaneous regression of lumbar disc herniation after weight loss: Case report. Turk Neurosurg, 2015, 25(4): 657-661.
19. Kim YH, Lee JY, Kim KH, et al. Comparative analysis on disc resorption rate of lumbar disc herniation patients after Korean medicine treatment and predictive factors associated with disc resorption. Journal of Korean Medicine Rehabilitation, 2018, 28(4): 33-41.
20. Tsarouhas A, Soufla G, Katonis P, et al. Transcript levels of major MMPs and ADAMTS-4 in relation to the clinicopathological profile of patients with lumbar disc herniation. Eur Spine J, 2011, 20(5): 781-790.
21. Ostafiński K, Świątnicki W, Szymański J, et al. Predicting conservative treatment failure in patients with lumbar disc herniation. Single center, case-control study. Clin Neurol Neurosurg, 2020, 193: 105867. doi: 10.1016/j.clineuro.2020.105867.
22. Vroomen PC, de Krom MC, Knottnerus JA. Predicting the outcome of sciatica at short-term follow-up. Br J Gen Pract, 2002, 52(475): 119-123.
23. Mochida K, Komori H, Okawa A, et al. Regression of cervical disc herniation observed on magnetic resonance images. Spine (Phila Pa 1976), 1998, 23(9): 990-997.
24. Rätsep T, Minajeva A, Asser T. Relationship between neovascularization and degenerative changes in herniated lumbar intervertebral discs. Eur Spine J, 2013, 22(11): 2474-2480.
25. Arai Y, Yasuma T, Shitoto K, et al. Immunohistological study of intervertebral disc herniation of lumbar spine. J Orthop Sci, 2000, 5(3): 229-231.
26. Borota L, Jonasson P, Agolli A. Spontaneous resorption of intradural lumbar disc fragments. Spine J, 2008, 8(2): 397-403.
27. Morozumi N, Aizawa T, Sasaki M, et al. Spontaneous resorption of intradural lumbar disc herniation: A rare case report. Spine Surg Relat Res, 2019, 4(3): 277-279.
28. Haro H, Nishiga M, Ishii D, et al. Experimental chemonucleolysis with recombinant human matrix metalloproteinase 7 in human herniated discs and dogs. Spine J, 2014, 14(7): 1280-1290.
29. Hatano E, Fujita T, Ueda Y, et al. Expression of ADAMTS-4 (aggrecanase-1) and possible involvement in regression of lumbar disc herniation. Spine (Phila Pa 1976), 2006, 31(13): 1426-1432.
30. Haro H, Shinomiya K, Komori H, et al. Upregulated expression of chemokines in herniated nucleus pulposus resorption. Spine (Phila Pa 1976), 1996, 21(14): 1647-1652.
31. Park JB, Chang H, Kim KW. Expression of Fas ligand and apoptosis of disc cells in herniated lumbar disc tissue. Spine (Phila Pa 1976), 2001, 26(6): 618-621.
32. Wang Z, Wang G, Zhu X, et al. Interleukin-2 is upregulated in patients with a prolapsed lumbar intervertebral disc and modulates cell proliferation, apoptosis and extracellular matrix metabolism of human nucleus pulposus cells. Exp Ther Med, 2015, 10(6): 2437-2443.
33. Ha KY, Koh IJ, Kirpalani PA, et al. The expression of hypoxia inducible factor-1alpha and apoptosis in herniated discs. Spine (Phila Pa 1976), 2006, 31(12): 1309-1313.
34. 刘锦涛, 姜宏, 王拥军, 等. 大鼠破裂型椎间盘突出模型的建立及突出物重吸收机制的研究. 中国骨伤, 2006, 31(12): 1309-1313.
35. Iwabuchi M, Murakami K, Ara F, et al. The predictive factors for the resorption of a lumbar disc herniation on plain MRI. Fukushima J Med Sci, 2010, 56(2): 91-97.
36. Yamashita K, Hiroshima K, Kurata A. Gadolinium-DTPA—enhanced magnetic resonance imaging of a sequestered lumbar intervertebral disc and its correlation with pathologic findings. Spine (Phila Pa 1976), 1994, 19(4): 479-482.
37. Ma Z, Yu P, Jiang H, et al. Conservative treatment for giant lumbar disc herniation: Clinical study in 409 cases. Pain Physician, 2021, 24(5): E639-E648.
38. Djuric N, Yang X, Barzouhi AE, et al. Gadolinium enhancement is not associated with disc inflammation in patients with sciatica. Spine (Phila Pa 1976), 2019, 44(12): E742-E748.
39. Ramos Amador A, Alcaraz Mexía M, González Preciado JL, et al. Natural history of lumbar disc hernias: does gadolinium enhancement have any prognostic value? Radiologia, 2013, 55(5): 398-407.
40. Sinnecker T, Bozin I, Dörr J, et al. Periventricular venous density in multiple sclerosis is inversely associated with T2 lesion count: a7 Tesla MRI study. Mult Scler, 2013, 19(3): 316-325.
41. Demirel A, Yorubulut M, Ergun N. Regression of lumbar disc herniation by physiotherapy. Does non-surgical spinal decompression therapy make a difference? Double-blind randomized controlled trial. J Back Musculoskelet Rehabil, 2017, 30(5): 1015-1022.
42. Buttermann GR. Lumbar disc herniation regression after successful epidural steroid injection. J Spinal Disord Tech, 2002, 15(6): 469-476.
43. Haro H, Domoto T, Maekawa S, et al. Resorption of thoracic disc herniation. Report of 2 cases. J Neurosurg Spine, 2008, 8(3): 300-304.
44. Hong SJ, Kim DY, Kim H, et al. Resorption of massive lumbar disc herniation on MRI treated with epidural steroid injection: A retrospective study of 28 cases. Pain Physician, 2016, 19(6): 381-388.
45. Aydin MV, Sen O, Kayaselcuk F, et al. Analysis and prevalence of inflammatory cells in subtypes of lumbar disc herniations under cyclooxygenase-2 inhibitor therapy. Neurol Res, 2005, 27(6): 609-612.
46. 苏彩风. COX-2抑制剂对腰椎间盘突出影响的实验研究. 武汉: 华中科技大学, 2008.
47. Sucuoğlu H, Barut AY. Clinical and radiological follow-up results of patients with sequestered lumbar disc herniation: A prospective cohort study. Med Princ Pract, 2021, 30(3): 244-252.
48. Overdevest GM, Vleggeert-Lankamp CL, Jacobs WC, et al. Recovery of motor deficit accompanying sciatica-subgroup analysis of a randomized controlled trial. Spine J, 2014, 14(9): 1817-1824.
49. Jha V, Deep G, Pandita N, et al. Factors affecting urinary outcome after delayed decompression in complete cauda equina syndrome: “A regression model study”. Eur J Trauma Emerg Surg, 2022, 48(2): 1009-1016.
50. Tarukado K, Ikuta K, Fukutoku Y, et al. Spontaneous regression of posterior epidural migrated lumbar disc fragments: case series. Spine J, 2015, 15(6): e57-e62.

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