Spinal hernia, specifically lumbar disc hernia, can indeed undergo a process of spontaneous resorption, where the herniated disc material reduces or disappears without surgical intervention. This phenomenon has been documented in various scientific studies and reviews, providing evidence for its occurrence and mechanisms.
Evidence of Spinal Hernia Resorption
The first scientific reports discussing spontaneous resorption of herniated discs emerged in the mid-1980s, highlighting that this process is not only possible but also a documented occurrence in clinical settings. Since then, numerous studies have reinforced the idea that herniated discs can regress over time, particularly with conservative treatment approaches such as physical therapy and pain management.
Magnetic Resonance Imaging (MRI) has played a crucial role in documenting the resorption of herniated discs. Studies have shown that many patients exhibit significant changes in the size of the herniated material over time. For instance, a systematic review indicated that spontaneous resorption is observable in a substantial percentage of cases, with MRI providing clear evidence of these changes.
The mechanisms behind disc resorption are multifactorial and involve:
Spinal herniation, particularly lumbar disc herniation (LDH), can undergo spontaneous resorption, a phenomenon supported by various scientific studies. Here are studies that provide evidence for the resorption of herniated discs:
1. A recent narrative review published in 2023 hypothesizes that nearly 70% of lumbar herniated nucleus pulposus (HNP) undergo significant resorption after acute herniation. This review analyzed 68 articles and highlighted various mechanisms involved in disc resorption, including inflammation, neovascularization, and dehydration. Factors that increase the likelihood of resorption include the initial size of the herniation and the presence of inflammatory mediators. The study emphasizes the importance of conservative management before considering surgical options, as many cases of herniation can improve without invasive intervention.
2. A comprehensive review published in Arthritis Research & Therapy discusses the spontaneous absorption of lumbar disc herniation and summarizes the biological mechanisms involved, such as macrophage infiltration and matrix remodeling. The authors note that as the degree of herniation decreases, clinical symptoms also improve, supporting the notion that many patients experience significant relief from symptoms as the herniated material is reabsorbed. This study underscores the need for further research to clarify predictive factors for resorption, which can aid in clinical decision-making for conservative treatment options.
3. Another study provides insights into the clinical and imaging features that favor natural absorption of herniated intervertebral discs. It discusses how imaging techniques like MRI have documented cases where the herniated portion of the intervertebral disc shrinks or disappears over time without surgical intervention. The study emphasizes that the composition of the herniated disc, particularly the presence of nucleus pulposus, plays a significant role in the likelihood of resorption, as this tissue is more prone to reabsorption due to its high water content and lower degree of degeneration.
4. Longitudinal studies have shown that many patients with lumbar disc herniation experience spontaneous resorption over time. For instance, a meta-analysis reviewing multiple studies concluded that a significant percentage of patients with LDH exhibit a reduction in herniated disc size and improvement in symptoms after conservative treatment, reinforcing the idea that surgical intervention is not always necessary.
The evidence from these studies clearly indicates that spontaneous resorption of spinal herniation is a real phenomenon, influenced by various biological and clinical factors. Understanding these mechanisms not only informs treatment strategies but also encourages a more conservative approach to managing lumbar disc herniation, allowing the body’s natural processes to facilitate recovery. Many clinicians advocate for conservative management of lumbar disc herniation, emphasizing physical therapy and monitoring over immediate surgical intervention. This approach aligns with findings that a considerable number of patients experience relief and reduction in herniated disc size without surgery.
How does a herniated disc happen?
A spinal hernia is a health condition in which the gel-like mass between the two vertebrae (the nucleus of the intervertebral disc) bursts through the weakest point into the spinal canal or into the openings between the vertebrae where our spinal cord and nerve roots hide. The erupted gel-like mass often compresses and irritates those nerve roots. Depending on the type and degree of the hernia tissue compressed and the degree to which the patient's musculoskeletal system is unbalanced, the symptoms range from complete numbness to severe pain, movement, and sensory disturbances. Perhaps most commonly felt acute, stabbing lumbar, thoracic, or neck pain, spinal movements become painful. Innervated by a compressed nerve the pain spreads to other parts of the body: arms, buttocks, legs, ribs.
First of all, it is important to emphasize that the formation of a disc herniation is slow and long process. It is also true that a disc herniation can occur suddenly, due to an injury, but even then, it is most likely caused by a pre-existing disorder in the musculoskeletal system.
Jonas Girskis, physical medicine and rehabilitation doctor, neurologist, summarizes the formation of spinal disc herniation: “First of all, the factor of irregular movement in our body causes differences in muscle tension. Over time, this changes the axis of the spine and the position of the joints, resulting in irregular directions of gravitational force to the intervertebral discs and joints, which are constantly traumatized. The ruptures in the fibrous ring of the intervertebral disc increase. As a result, the disc swells, protrudes beyond its anatomical boundaries, and encounters the nerve root of the spine, which gets episodically irritated. Eventually, the fibrous ring of the intervertebral disc ruptures. A soft nucleus erupts through the cracks and compresses the nerve root. The formed disc herniation causes spasms of the muscles around the spine, overstretching the surrounding ligaments. And the circle of flawed consequences takes off: the spine is twisted to the side, and it is often turned around the longitudinal axis. Biologically active substances that irritate pain receptors erupt from the intervertebral disc. All this causes pain and other unpleasant sensations.
Rebuilding Biomechanical Harmony
“We successfully treated hundreds of patients at our Spine treatment center who have previously been scheduled for surgery but reconsidered. They achieved excellent results thanks to their persistence, willpower, and correct application of physical medicine and rehabilitation techniques – says Dr. Jonas Girskis, based on medical science and his almost 40 years of disc herniation treatment practice.
“First of all, we must look for impaired biomechanical links in the musculoskeletal system, and then next step - we should use biomechanically targeted therapeutic exercises - physiotherapy. I must emphasize, by no means should we use general exercises that are intended for physical activity, but not for treatment," says Dr. Girskis.
Physical medicine and rehabilitation doctor R. Burzdžienė, based on her professional experience gives the answer to the frequently asked question about how long it takes to restore biomechanical balance: "The duration of treatment depends on the patient's motivation because it is up to a person how much work he/she will put in to correct the musculoskeletal imbalance that has become the cause of the disc rupture. It is also important how much pressure the nerve root is under and how skilled his/her physician is. In this case, targeted therapeutic exercises are necessary. Although the pain may decrease after a few weeks or months, the correction of the musculoskeletal system and the restoration of normal body biomechanics may take years and longer.”
In the case of a large hernia, which severely narrows the spinal canal, there may be difficulty or inability to urinate, "saddle-type" numbness of the genitals and the inner thigh. These symptoms are rare but very serious and should be treated urgently by a neurosurgeon – says Dr. Jonas Girskis.
So, the first action when you hear the diagnosis of spinal disc herniation is assessing the biomechanics of your body. The better we understand the problems that arise and know how to deal with them, the milder the effects of the disease will be.
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Enjoy your smart journey to wellness!
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