- Department of Neurosciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
Dinesh Naidoo, Department of Neurosciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
DOI:10.25259/SNI_491_2021Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Dinesh Naidoo. Spontaneous and rapid resolution of a massive lumbar disc herniation. 19-Jul-2021;12:352
How to cite this URL: Dinesh Naidoo. Spontaneous and rapid resolution of a massive lumbar disc herniation. 19-Jul-2021;12:352. Available from: https://surgicalneurologyint.com/surgicalint-articles/10986/
Background: Most lumbar disc herniations can be successfully treated conservatively. However, massive lumbar disc herniations are often treated surgically to avoid permanent cauda equina syndromes/neurological deficits and potential litigation. Nevertheless, here, we present a 51-year-old female who refused lumbar surgery due to coronavirus disease 2019 (COVID-19) and sustained a full spontaneous recovery without surgical intervention.
Case Description: A 51-year-old female presented with a massive lumbar disc herniation at the L5S1 level. Despite refusing surgery for fear of getting COVID-19, she spontaneously neurologically improved without any residual neurological or radiographic sequelae.
Conclusion: Although the vast majority of patients with massive lumbar disc herniations are managed surgically, there are rare instances in which nonoperative management may be successful.
Keywords: Cauda equina syndrome, Conservative treatment, Coronavirus disease 2019, Litigation, Massive lumbar disc
The first radiological demonstration of the spontaneous regression of a lumbar disc herniation was published in 1984[
Nevertheless, most spinal surgeons are reluctant to treat massive lumbar disc herniations conservatively due to the risk for developing a CES and permanent neurological sequelae.[
A 51-year-old female presented with a 1-day history of the spontaneous onset of lower back pain radiating to both legs. On examination, she had mild right-sided plantar flexion weakness (4/5), without any bladder nor bowel disturbance.
Patient refused surgery
The patient refused surgery as she was afraid that a hospital admission could result in her contracting coronavirus disease 2019 (COVID-19). Rather, she was treated with nonsteroidal anti-inflammatory medication, gabapentin, and weekly clinical examinations. Notably, we clearly discussed the risks/ complications of her developing a CES and the potential for a permanent, irreversible neurological injury/deficit.
The patient spontaneously improved and was able to return to work within 2 weeks. Three months later, she was neurologically normal, and the repeat MRI scan showed near-complete resolution of the original L5S1 massive disc herniation [
All patients were treated conservatively due to patient choice and because none presented with CES. The six studies yielded a total of 117 patients with massive lumbar disc herniations, treated conservatively for whom follow-up to symptomatic or radiological resolution or both were available. Although six patients eventually required surgery; only one patient underwent surgery for an impending CES, making an uneventful recovery.[
Due to the fear of contracting COVID-19, a 51-year-old female with a massive L5S1 disc herniation but minimal neurological deficit pursued a nonsurgical route resulting in full spontaneous resolution of her deficit and original MRI findings (3 months later).
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