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Images in Neurology
January 2018

Spontaneous Disappearance of Large Lumbar Disk Herniation

Author Affiliations
  • 1Department of Spine, Affiliated Hospital of Binzhou Medical University, Binzhou, China
JAMA Neurol. 2018;75(1):123-124. doi:10.1001/jamaneurol.2017.3178

A woman in her 40s using a wheelchair presented to our spine clinic with a 2-month history of persistent pain in her left leg and difficulty walking. Physical findings included hypoesthesia, motor strength of 4 on a scale of 0 to 5 (where 0 indicates no contraction and 5 indicates normal strength), and the ability to raise her lower left leg to 50° when straightened. Magnetic resonance imaging of the lumbar spine revealed a large herniated disk at the level of L3 and L4, resulting in compression of the nerve root (Figure, A). The patient noted that she required a wheelchair for ambulation owing to the pain in her leg. Considering that the disease had greatly affected her daily life, surgical decompression of the lumbar spine was recommended. However, owing to trepidation regarding surgery and complications, the patient chose conservative therapy. The patient was also advised to perform functional exercises, sleep on a hard bed, and continue surveillance via magnetic resonance imaging. One month later, she stated that her leg pain was markedly relieved. Results of physical examinations were normal except for motor strength of 4 (on a scale of 0-5) in the quadriceps and tibialis anterior. Results of a second magnetic resonance imaging study at that time revealed partial absorption of the large herniated disk (Figure, B). Eight months after the patient’s initial visit, no residual symptoms or physical signs were found. At that time, results of a third magnetic resonance imaging study revealed that the large herniated disk was no longer visible (Figure, C).

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