突出椎间盘自然吸收现象的回顾性研究

The spontaneous resolution of the herniation——a retrospective study

目的：研究突出椎间盘自然吸收的现象，为腰椎间盘突出症的非手术或手术治疗选择提供依据。方法对18例发生突出椎间盘自然吸收现象患者的病程、症状、体征及影像学资料进行回顾性分析。结果所有患者均为破碎型突出。18例均获随访，时间6-72（17±15）个月。突出物吸收率：完全消失12例，显著缩小6例。其中1例后纵韧带破裂者遗留少许腰痛，跟腱反射未恢复，但能正常工作及生活；另有1例腰腿痛复发，影像学显示突出间盘缩小后再次大块脱出，后纵韧带破裂；其余患者症状体征完全恢复，腰椎主动活动自如。结论腰椎间盘突出症如果后纵韧带完整，即使突出物巨大，症状重，只要没有马尾综合征或进行性单根神经根麻痹，都可以进行非手术治疗，且预后良好；但椎间盘吸收后在合适的条件下可再次突出。

Objective In order to provide identifiable ground for surgical or nonoperative treatment for lumbar disc herniation, the phenomenon of spontaneous resolution of the herniation was studied. Methods 18 subjects whose herniation was absorbed were enrolled, their natural history, symptom, sign and image datas were analyzed. Results All the cases were extrusion, at a follow-up of 6-72 （17 ± 15）months. The herniated discs disappeared in 12 ca-ses, 6 cases had a reduction of more than 50%. Posterior longitudinal ligament was torn in one case, mildly low back pain was remained and Achilles tendon reflex did not recovered, but the patient could work normally. Another case suffered a relapse of severe sciatica, MRI scans showed the disc extruded again, and posterior longitudinal ligament was torn. The remaining patients showed excellent results. Conclusions When the posterior longitudinal ligament is in integrity, no signs of ingravescent never damage or cauda equina syndrome, which can adopt a conservative treat-ment policy, even if herniated disc is enormous and sciatica is severe, and the result is good. However, the disc may herniate again.