Spontaneous Remission of a Big Subligamentous Extruded Disc Herniation: Case Report and Review of the Literature

Spontaneous Regression of a Big Subligamentous Extruded Disc Herniation: Case Report And Review of The Literature The most efficient method for the treatment of lumbar disc herniation is still controversial. The most important aspect is the application of the suitable conservative or surgical treatment to the right patient at the right time. In lumbar disc herniation patients, one must not precipitate except for cases that require surgical indications as in cauda equina syndrome, evolutive motor deficit and persistence of pain in spite of the narcotics. However, the spontaneous regression mechanism has not been completely determined yet. The proposed hypotheses are; dehydration, retraction of the disc to the hernia in the annulus fibrosis, enzymatic catabolism and phagocytosis. In this study, the case of a patient with huge lumbar disc hernia regressing by itself has been presented and the potential mechanisms of disc regression have been discussed.

The diagnosis and surgical treatment for compressive lesions of spinal nerve root, spinal cord of cervix, thorax and lumbar spine in Mongolia / Монголын Анагаах Ухаан

Background: Spine disorder is the first cause of disability of workers below 45 years and economicalburden costs 20-50 billion us.dol, in European countries. Lumbar disc hernia estimates 40% of 30-50aged population in U.S and in Japan 26/10000. In last 5 years, spine surgeries increased in 4-5 timesdue intervertebral disc hernia, at Shastin State Third Central hospital of Mongolia.Goal: To populate new methods of surgical treatment for compressive lesions of spinal cord, spinalnerve root of cervix, thorax and lumbar spineMaterials and Methods: We did clinical research involving patients who had spine surgery at ourdepartment due “compressive lesion of spinal nerve root and spinal cord”. From, total 217 patients,excluded 9. Excluded cases are: declined from surgery 3, Arnold-Chiari malformation 5, and epiduralabscess 1. We collected data with permission of patient and did statistical analysis by IBM SPSS 17.Results: The surgery for intervertebral disc hernia takes 84.6% (176) of total surgery and 94.9% (167)of lumbar disease. Tumor of spinal cord estimates 9.1% (19) of total case, dominates in lumbar area(57.9%). We used posterior approach mostly, because it is frequently used in lumbar spine. The surgerycontinued 36-750 min (204.6, SD 128.5) ten patients (4.8%) had complications. In this project weused 5 surgical methods totally in solitary or combined. Spondilodesis is the most combined methodamong them. We used Oswestry disability index in Mongolia at first, to count treatment effect. Currentindex evaluated pre and post surgery period. Patient complaint and difficulty of daily life progressivelydecreased after surgery and almost disappeared at third month (p<0.00).Conclusion:1. It is possible to develop international standard surgical treatment of compressive lesions of spinalnerve root, spinal cord of cervix, thorax and lumbar spine in Mongolia.2. We used Oswestry disability index in Mongolia at first, so this questionnaire is simpler and accuratemethod for spine, spinal cord induced disability.3. Twenty seven point nine percent of patients who had surgical treatment has minimal to moderatedisability by Oswestry disability index, so it means we have to process standard of spine surgeryand increase non surgical treatment efficiency.4. Working ability recovers faster when spine surgery has been done.5. These new methods of spine surgery are cost effective than same surgery which will be doneabroad.