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Chiropractic Research Review

Herniated Discs: Does Initial Size Predict Clinical Improvement?

Larger initial disc herniations may contribute to greater subsequent regression of the herniated fragment. Regression of the herniated disc has been associated with the prediction of positive outcomes of conservative treatment in patients with radiculopathy, although the extent of regression necessary for symptom improvement remains poorly defined.

A study involving 36 patients investigated the effect of transligamentous extension through the posterior longitudinal ligament (PLL) of herniated discs on disc regression. All patients had symptomatic lumbar disc herniations and received conservative treatment. Patients were divided into three groups based on herniation type (subligamentous, transligamentous, or sequestered), and clinical outcomes and magnetic resonance images (MRI) were analyzed. Results showed that:

* Twenty-five of the 36 herniated discs decreased in size following transligamentous extension.

* Ten of 18 subligamentous herniations, 11 of 14 transligamentous herniations, and all four sequestered herniations were also reduced in size.

* Average decreases in herniation ratio were 17% (subligamentous); 48% (transligamentous); and 82% (sequestered).

* Decrease in herniation ratio was related to transligamentous extension but not initial size of the herniation.

These results suggest that trans-ligamentous extension of herniated disc materials through the ruptured posterior longitudinal ligament is an important factor in size reduction, more important than the initial size of the herniation. It is thought that the resorption of herniated disc material is caused by phagocytosis from the vascular supply in epidural fat tissues through the ruptured PLL, whereas in the absence of a PLL rupture, resorption would be reduced. The authors also note that 20% regression of the herniation appears necessary for successful clinical outcome.

Note: As greater research is produced pertaining to disc injuries, our understanding of the pathophysiology of these disorders increases. Reading this study is a great way to update your knowledge about herniated lumbar discs, focusing more on the body's response through inflammatory mediation and less so on mechanical compression.

Ahn SH, Ahn MW, Byun WM. Effect of the transligamentous extension of lumbar disc herniations on their regression and the clinical outcome of sciatica. Spine, Feb. 15, 2000:25(4), pp475-80.

Chiropractic Research Review

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