Spontaneous Regression of the Sequestrated Cervical Discs: A Prospective Study of 70 Cases

Abstract

The validity of conservative management in certain type of acute cervical disc herniation based on amelioration of brachialgia has been described previously. But, disappearance of radiculopathy secondary to spontaneous resolution of the disc material being demonstrated in control MRI has been sporadically reported as a case report or small series. Herein we will describe 70 carefully selected patients with acute mono-radiculopathy due to cervical soft disc herniation. These cases were enrolled in a prospective study for the possibility of their spontaneous resolution with time. For the possibility spontaneous resolution of the sequestrated disc material, periodic MRI was used. In parallel, pain intensity at the onset and its intensity at the time of its complete resolution were assessed via Visual Analogue Scale (VAS). Mixed-design repeated measures ANOVA and independent sample T-test were carried out to determine the effects of this kind of treatment on pain intensity and ultimate outcome of the patients. Surprisingly, spontaneous resolution of the sequestrated disc material was observed in control MRI, in all 70 recruited patients, in duration with mean of 5.71 ± 1.49 months. Furthermore, despite severity of the pain at the onset, amelioration of radiculopathy occurred with significant decrease in VAS score with initial intensity from mean of 9.30 ± 0.80 to mean of 0.90 ± 0.76, after disappearance of the offending disc material. The details of the current series which is the first prospective one in the literature might offer a strong clue about the validity of conservative management in certain type of acute cervical disc herniation. The current report may advocate the neurosurgeons to allow the nature to resolve its problem with its own alterations in due time in sequestrated cervical disc herniation’s in the absence of neurological deficit.