In this study 47% of cervical disc herniations decreased in size by 75 to 100% without surgery!
This study demonstrates large conservatively treated herniations frequently decrease in size by more than 75%. The largest herniations have the greatest tendancy to decrease in size. The authors report the regression of cervical disc herniations appears to follow the same course as that of lumbar herniations. Most disc protrusions progressively decrease in size and eventually---disappear.
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Maigne JY; Deligne L.
Computed tomographic follow-up study of 21 cases of nonoperatively treated cervical
intervertebral soft disc herniation.
Spine, 1994 Jan 15, 19(2):189-91.
Abstract: The authors studied the natural evolution of cervical soft disc herniations in 21 patients with cervical radiculopathy that was successfully treated with conservative therapy only. The first computed tomography (CT) examination was performed during the acute phase of the radiculopathy, and the second performed from 1 to 30 months after healing. The initial CT allowed classification of the herniations according to size: nine were considered small, seven medium, and five large. Comparison with follow-up scans showed that five of the herniations decreased between 0 and 35%, six decreased between 35 and 75% and ten decreased between 75 and 100%. The largest herniations were those that had the greatest tendency to decrease in size. This tendency could be secondary to the herniation breaking through the outer fibers of the anulus and entering the epidural space.
Ellenberg MR; Ross ML; Honet JC; Schwartz M; Chodoroff G; Enochs S.
Prospective evaluation of the course of disc herniations in patients with
proven radiculopathy.
Archives of Physical Medicine and Rehabilitation, 1993 Jan, 74(1):3-8.
(UI: 93129096)
Abstract: Although surgery is often recommended as the definitive treatment for radiculopathy when definite disc herniation is demonstrated with imaging techniques, complete improvement can occur with nonoperative treatment. However, what happens to the disc in the latter circumstance is not well defined. We report the first prospective study in subjects with proven radiculopathy and definite disc herniation who improve with nonoperative management to determine what occurs to the herniated disc material. Eighteen subjects with lower extremity pain or paresthesia, positive straight leg raising, weakness in a myotomal distribution, reflex asymmetry, or electromyogram evidence of radiculopathy were studied. Subjects were admitted to the study if computed tomography (CT) scanning demonstrated definite disc herniation corresponding to the side and level of the radiculopathy. After complete clinical improvement, repeat CT scan was performed at six to 18 months after the initial study. The CT scans were interpreted separately by two neuroradiologists. Disc herniations were characterized by size (large, moderate, or minimal); the presence of absence of free fragments; and location. Follow-up scans were compared with the original study and characterized as resolved, improved, or unchanged. Fourteen subjects completed the study, an additional three had operative treatment, and one refused repeat scanning. Subjects were followed an average of 30.4 months with no recurrence of radicular symptoms during this follow-up period in 13 patients. One had recurrence of symptoms at 21 months and surgery at 26 months. Six follow-up scans (43%) were interpreted as completely resolved, five (36%) as improved, and three (21%) as unchanged. Among the 13 nonoperated patients, there was no difference in outcome whether they had resolution, improvement, or no change of their disc herniation on follow-up CT scan. Patients with definite radiculopathy and definite disc herniations can improve with nonoperative treatment (15 of 18, or 83%). The disc herniations themselves resolved or improved in 78% of cases. Patients without demonstrated resolution or improvement in the disc herniation may still show a complete clinical improvement without recurrence over a 2 1/2 year follow-up.