L_(3-4)椎间盘突出自发性吸收并L_4-S_1椎间盘突出加重1例报道

Spontaneous regression of herniated L_(3-4) intervertebral disc with L_(4-5) and L_5-S_1 disc herniation progression in one patient

腰椎间盘突出自发性吸收偶见报道。本文报道1例单节段腰椎间盘突出自发性吸收并其它节段椎间盘突出进展加重。患者女性,1942年出生,2013-12-19因右侧腰腿痛MR证实为L_(3-4)椎间盘右极外侧型突出,同时有无症状性L_(4-5)椎间盘膨出及L_5-S_1椎间盘中央型突出。经保守治疗症状消失。2014年6月MR复查L_(3-4)突出椎间盘缩小。2016年6月患者新发左侧腰腿痛,CT及MR检查发现L_(3-4)突出间盘消失,出现症状性L_(4-5)椎间盘突出并左侧黄韧带肥厚及无症状性L_5-S_1椎间盘右椎间孔型突出。患者经保守治疗,症状再次缓解。提示同一患者可在某一节段突出椎间盘自发吸收同时或先后出现其它节段间盘突出或突出增大。具体机制有待于进一步研究。

Spontaneous regression of herniated lumbar discs was reported occasionally.This paper described and discussed one case of spontaneous regression of herniated lumbar disc with new disc herniation and herniation development at other levels.The female patient was born in 1942.Lumbar spinal MR taken on December 19,2013 revealed she had symptomatic far-lateral L3-4 disc herniation at right side,asymptomatic L4-5 disc bulge and L5-S1 disc herniation of central type when she complained of lumbago and radiating right lower extremity pain.Her symptoms disappeared after conservative treatment.MR re-examination of lumbar spine on June,2014 revealed the herniated L3-4 disc reabsorbed partially.On June,2016 low back pain and radiating lower extremity pain at left side emerged.This time CT and MR examination revealed the patient developed symptomatic L4-5 disc herniation of central type with thickening of left L4-5 flavum ligament,which resulted in left L4-5 lateral recess stenosis and asymptomatic L5-S1 lumbar disc herniation of right far-lateral type,while the original herniated L3-4 disc reabsorbed completely.After conservative treatment,the patient’s newemerged symptoms alleviated again.This case indicated that spontaneous regression of herniated lumbar disc at one level with new disc herniation or herniation development at different level(s)could occur spontaneously or subsequently in one patient.The precise mechanisms need further research.