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After 2 years, follow-up MRI study (T2-weighted image) of the cervical spine (A, parasagittal; B, mid-sagittal; C, D, axial) showed complete spontaneous regression of the extrude disc at the C4-5 level without right C5 root compression.
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Spontaneous regression of cervical disc herniation is a rare, and such reports are few. A 39 year-old woman complained of severe neck pain associated with tingling and numbness of right upper extremity. The MRI of the cervical spine revealed a posterior disc extrusion at the C4-C5 level in the right para-central location. The patient was treated wi...
Context in source publication
Context 1
... multiple sessions of physical therapy. After 3 weeks treatment, the patient's symp- toms were significant improvement. After two years later, she re-visited our hospital because of developed neck pain recently. We performed follow-up cervical MRI that revealed significant spontaneous regression of the C4-C5 intervertebral disc extru- sion (Fig. 2). The patient's symptoms were alleviated sponta- neously after 2 ...
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Citations
... There are no conflicts of interest. [17] 6 Radiculopathy -6 C4-C5; C5-C6 (2 cases); C6-C7 (3 cases) Rahimizadeh et al., 2013 [18] 26 Radiculopathy -26 C5-C6 (16 cases); C6-C7 (10 cases) Turk and Yaldiz, 2019 [19] 14 Radiculopathy -14 C4-C5 (4 cases); C5-C6 (5 cases); C6-C7 (5 cases) Krieger and Maniker, 1992 [5] 38/male Radiculopathy Absent C5-C6 12 Westmark et al., 1997 [6] 48/female Radiculopathy Absent C6-C7 24 Song et al., 1999 [7] 37/female Myelopathy Absent C5-C6 28 Kobayashi et al., 2003 [8] 27/male Radiculopathy Absent C5-C6 12 Benzagmout et al., 2007 [9] 48/male Radiculopathy Absent C5-C6 3 Stavrinou et al., 2009 [10] 46/male Myelopathy Absent C5-C6 1.75 Pan et al., 2010 [11] 32/male Myelopathy Absent C6-C7 6 Orief et al., 2012 [12] 40/male Radiculopathy Absent C5-C6 5 Mahajan et al., 2014 [13] 29/male Radiculopathy Absent C5-C6 5 Han and Choi, 2014 [14] 39/female Radiculopathy Absent C4-C5 24 Sharma et al., 2021 [1] 24 ...
We report the case of a 60‑year‑old male, who presented to us with a 6‑month‑old quadriparesis (upper limbs 3/5; lower limbs 0/5), secondary to a posttraumatic C5‑C6/C6‑C7 prolapsed intervertebral disc (PIVD), and a D4‑D5 fracture‑dislocation, resulting in a physiological dorsal cord transection. The patient had been managed conservatively outside. In view of the insignificant neurological recovery over the past 6 months, the patient consulted for a second opinion. At the time, the patient also had an infected decubitus ulcer. Due to the significant thecal compression at the C5‑C6 level, and the partial improvement in upper limbs power, we suspected a possible ongoing dynamic cord injury. The patient was planned for an anterior cervical discectomy and fusion at the C5‑C6 level once the decubitus ulcer was managed. After a month, with the patient’s pressure sore healed, a repeat magnetic resonance imaging cervico‑dorsal spine showed a near‑complete spontaneous regression of the C5‑C6 PIVD.
... There are signs that these M2 macrophages are implicated in IVD extrusion. In fact, spontaneous resorption of a herniated disc has been documented several times in the literature (36)(37)(38)(39)(40)(41)(42). The inflammatory response has been suggested to play a major role in this phenomenon. ...
Introduction: Canine interverterbral disc (IVD), although physiologically acellular, displays an inflammatory cell population consisting almost exclusively of macrophages (Mϕ) when acutely herniated. Mϕ encompass a heterogenous cell population, roughly divided into classically (M1) or alternatively activated (M2)Mϕ. Polarization into M1 Mϕ leads to strong antimicrobial activity and pro-inflammatory response. In contrast, M2Mϕ exibit anti-inflammatory function and regulate wound healing. The purpose of this study was to characterize the phenotype of the Mϕ population present in naturally occurring IVD herniation.
Materials and Methods: IVD material of dogs with IVD disease was collected during standard decompressive surgery. A negative control consisting of IVD material of dogs without IVD degeneration and a positive control consisting of canine liver and lymph node samples were also included. All samples were embedded in OCT and shock frozen. Eight micrometer cryostat sections were prepared, air dried and immunostained without prefixation or permeabilization. CD14 was used as marker Mϕ, MHCII for M1Mϕ and CD206 for M2Mϕ.
Results: Fifteen samples of dogs with IVD herniation, 10 negative, and 5 positive control samples were obtained. No positive cell was found in the negative control group. The positive control group displayed several MHCII and CD206 positive cells, all of them being simultaneously positive to CD14. All herniated samples displayed a mixed population of M1Mϕ and M2Mϕ, and some sparse Mϕ displaying markers for both M1 and M2Mϕ simultaneously.
Conclusion: The mixed phenotype encountered shows the plasticity and dynamism of Mϕ and evidences the chronic component of IVD disease despite its acute clinical presentation.
... 10 It has also been observed that larger herniations are more likely to regress, which could be in relation to a greater inflammatory response. 11 More work is needed in order to establish the relevance of this in dogs and when canine extrusions may be more or less likely to regress. ...
Spontaneous regression of cervical intervertebral disc extrusion (cIVDE) has been reported in people. It has also been reported in a dog after four months of medical management. Two French bulldogs were presented to two different referral centres for signs of neck pain or myoclonic twitching. Both were diagnosed with cIVDE on MRI and were managed medically. One dog re-presented after six weeks with recurrent signs while it was still being strictly rested. Repeat MRI showed a new disc extrusion with apparent spontaneous regression of the initial cIVDE. The same re-presentation occurred in the second dog with a year intermission. These two cases demonstrate that spontaneous regression of intervertebral disc extrusion is a phenomenon occurring in the cervical spine of dogs. Notably one dog had a new disc extrusion during a period of rest, thus illustrating that further work is needed to understand how best to utilise medical management and crate rest.
... Rahimizadeh et al. have reported 26 cases, Gürkanlar et al [10] 6 cases, Vinas et al [11] 4 cases, Mochida et al [12] 3 cases, a total of 9 cases with spontaneous regression was reported in literature until today. [8][9][10][11][12][13][14][15][16] Our study is the second large serial in the literature. When previous case reports and serials were analyzed, C5-C6 and C6-C7 were seen to be the locations where resorption is observed most. ...
Cervical disc herniation is a condition which arises from compression of cervical spinal nerve root by the degenerated disc and vast majority of the patients are aged between 30 and 40 years. Spontaneous regression of cervical disc was first reported by Kriegerand Maniker in 1992. Our study is the second large series in literature. Besides, 4 patients are the first who were shown to have resorption in C 4-5.
The records of patients diagnosed with cervical disc herniation who applied to the Spine Polyclinic between 2014 and 2018 were reviewed retrospectively. The files of the patients who were recommended surgery with the diagnosis of cervical disc herniation were examined. Patients who did not accept surgery on their own initiative, but who attended our outpatient clinic for a check-up were included in the study.
Of a total of 14 patients, 28.57% (n = 4) were male and 71.43% (n = 10) were female. Mean age of the patients was 40.79 (range 25–60).
The results of the study indicate that likelihood of spontaneous regression is higher in para-central or foraminal disc compared to central disc hernias. Although there are a limited number of case reports in the literature, conservative treatment seems to be a good option in patients without neurological deficits, with foraminal disc hernias and not requiring emergency surgery.
... The improvement of pain intensity observed in majority of the cases within the first few weeks after its appearance facilitate the study. However, in11 patients who couldn't tolerate their brachialgia, periradicular block was done being associated with significant decrease in pain intensity.. Therefore, the value and effectiveness of this mode of pain management will be described in brief [52][53][54][55][56][57][58]. ...
... Furthermore, the predictive value of MRI features, highly indicative of resolution will be discussed [52][53][54][55][56][57][58][59][60][61]. With demonstration of the promising effects of this study, the value of waiting strategy and the benign natural course of acute cervical soft disc herniation in a very selected group of the patients with only brachialgia is emphasized again. ...
... However, sometimes mono-radiculopathy is unremitting and of such intensity that some patients cannot continue conservative treatment and become ready for surgical intervention. It should be reminded that in such circumstances intractable pain can be controlled with periradicular nerve block with combination of corticosteroid and local anesthetics [52][53][54][55][56][57][58]. Periradicular block usually result in pain amelioration by which the patients might start their normal daily life [52][53][54][55][56][57][58]. ...
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.
... Spontaneus regression of disc herniation without any surgical treatment has been reported to occur in the cervical region. Most such cases are confined to disc herniation that are associated with radiculopathy [1][2][3][4][5][6][7][8]. We present a very rare case of spontaneous regression of cervical disc herniation in patient with myelopathy, that was demonstrated by MRI. ...
Introduction The aim of this work was to present a rare case of spontaneous regression of a herniated cervical disc in a patient with myelopathy. Case outline A 31-year-old women presented with two weeks’ history of neck pain associated with numbness in her body and all four extremities. Magnetic resonance imaging (MRI) of the cervical spine showed a large posterior medial disc extrusion at the C5–C6 spinal segment, causing myelopathy. The patient refused discectomy that was recommended. She received symptomatic treatment in the form of analgesics, a muscle relaxant, and a hard cervical collar. A follow-up MRI of the cervical spine, performed after 11 months, revealed almost complete regression of disc herniation. The patient’s symptoms subsided completely after one year. Conclusion In some cases of cervical disc herniation with myelopathy, especially in patients with mild neurological deficit, symptomatic therapy should be considered.
A 4‐year‐old, male, neutered Cavalier King Charles spaniel was referred to the neurology service with a 10‐day history of cervical hyperaesthesia. A low‐field magnetic resonance imaging scan of the cervical spine identified a large C7–T1 intervertebral disc extrusion, resulting in severe spinal cord compression. The patient was treated with conservative therapy (exercise restriction and analgesia for 4 weeks). Repeat magnetic resonance imaging of the cervical spine was performed 4 months after initial presentation, and identified spontaneous resorption of the extruded C7–T1 disc material. There are very few documented cases of spontaneously resorbed cervical intervertebral disc extrusions in canine patients following successful conservative therapy. To the authors’ knowledge, this is the first report of spontaneous resorption of an intervertebral disc extrusion at an unusual C7–T1 location confirmed via follow‐up low‐field magnetic resonance imaging following conservative therapy.
Background
We have reviewed 75 cases plus our own single instance of spontaneous regression of herniated cervical discs.
Methods
We searched PubMed and EMBASE databases (until September 2020) utilizing the following keywords; “spontaneous regression,” “herniated cervical disc,” and “Magnetic Resonance Imaging (MRI) studies.”
Results
In the literature, we found 75 cases of herniated cervical discs which spontaneously regressed; to this, we added our case. Patients averaged 40.95 years of age. Discs were paracentral or foraminal in 84% of the cases, with most occurring at the C5-C6 (51%) and C6-C7 (36%) levels. Symptoms included neck pain/radiculopathy (91%) or myelopathy (9%). The average interval between initial presentation and spontaneous regression of herniated discs on MRI was 9.15 months. Interestingly, on MRI, extruded/sequestrated discs were more likely to undergo spontaneous regression versus protruding discs.
Conclusion
Successive MRI studies documented the spontaneous regression of herniated cervical discs over an average of 9.15 months. Although this may prompt greater consideration for conservative treatment in younger patients without neurologic deficits, those with deficits should be considered for surgery.
This report describes, for the first time in small animal literature, the spontaneous resorption of herniated Hansen type intervertebral disc material in the cervical spine of a chondrodystrophic dog over a 4-month period, documented by magnetic resonance imaging. Clinical signs (cervical hyperpathia) responded to conservative treatment during the same period.
Acute two-level cervical soft disc herniation in a subject without underlying degenerative changes is rare. Only
3 cases could be found with a careful review of the literature. All such herniations are located in the midline,
presenting with either quadriparesis or Brown-Sequard syndrome. However, laterally located two-level acute
cervical sequestrated disc herniation with only radiculopathy seems to be extremely rare and not a single case
could be found in our review.
Herein, we present a young male who developed severe upper limb radiculopathy not responsive to medication.
MRI revealed two large cervical sequestrated discs located posterolaterally at the C5-C6 and C6-C7 levels. With
consideration of the severity of pain not responsive to medications, two-level arthroplasty was advocated, but
the patient refused despite pain intensity. Therefore, periradicular cervical block was done at 2 levels, which
caused dramatic pain relief thereafter. Conservative treatment was continued with NSAIDs and analgesics. A
week after the block, he restarted most of his previous activities. Three months later, follow-up MRI revealed
complete resolution of the corresponding sequestrated discs.
To our knowledge, acute two-level cervical disc herniation with brachialgia is extremely rare with no similar
case being found in the literature.
