Conservative treatment for patients with massive prolapsed lumber intervertebral discs


  • M. Nazrul Islam Department of Orthopaedics, Khulna Medical College, Khulna Bangladesh
  • S. M. Didarul Alam Department of Orthopaedics, Khulna Medical College Hospital, Khulna, Bangladesh
  • M. Imran Department of Orthopaedics, Sadar Hospital, Khulna, Bangladesh
  • M. Sahedur Rahman Department of Orthopaedics, Khulna Medical College Hospital, Khulna, Bangladesh
  • M. Tanveer Hasan Department of Orthopaedics, Khulna Medical College Hospital, Khulna, Bangladesh



Intervertebral disc, Discectomy, Magnetic resonance imaging, Natural history


Background: The natural history of Lumber hernia of nucleus pulpous is not fully known and absolute indications for surgical intervention cannot be established. Several studies have shown that the most giant discs appear to have the greatest tendency to resolve with conservative treatment. The objective of this study is to investigate whether massive prolapsed discs can be safely managed conservatively once clinical improvement has occurred.

Methods: Thirty-five patients were studied by clinical assessments and serial magnetic imaging over 3 years. Patients present with intense sciatica but began to show clinical improvement despite massive disc prolapsed. Clinical assessment included the Lasegue test and neurological improvement. The Oswestry disability index was used to measure function and changes in function. Serial MRI studies allowed the measurement of volume changes of the prolapsed disc material over some time.

Results: Initial follow-up at an average of 13.2 months showed that 87% had complete and sustained recovery at the initial follow-up. Only four patients required surgery. The average Oswestry disability index improved from 63% to 20%. Volumetric analysis of serial MRI scans showed an average reduction of 69% in disc size.

Conclusions: A massive disc prolapsed can pursue a favourable course. If early progress is shown, the long-term prognosis is very good and even massive disc prolapses can be treated conservatively.

Author Biography

M. Nazrul Islam, Department of Orthopaedics, Khulna Medical College, Khulna Bangladesh



Postacchini F. Results of surgery compared with conservative management for lumbar disc herniations. Spine. 1996;21:1383-7.

Ahn SH, Ahn MW, Byun WM. Effect of the transligamentoius extension of lumbar disc herniations on their regression and the clinical outcome of sciatica. Spine. 2000;25:475 80.

Bazzao A, Gallucci M, Masgiocchi C, Aprile I, Barile A, Passariello R. Lumbar disc herniation: MR imaging assessment of natural history in patients treated without surgery. Radiology. 1992;185:135-41.

Delauche-Cavallier MC, Budet C, Laredo JD, Debie B, Wybier M, Dorfmann H, et al. Lumbar disc herniation. Computed tomography scan changes after conservative treatment of nerve root compression, Spine. 1992:17:927-33.

Komori H, Shinomiya K, Nakai O, Yamaura I, Takeda S, Faruya K. The natural history of herniated nucleus pulposus with radiculopathy. Spine. 1996;21:225-9.

Matsubara Y, Kato F, Mimatsu K, Kajino G, Nakamura S, Nitta H. Serial changes on MRI in lumbar disc herniations treated conservatively. Neuroradiology. 1995;37:378-83.

Modic MT, Ross JS, Obuchowski NA, Browning KH, Cianflocco AJ, Mazanec DJ. Contrast-enhanced MR imaging in acute lumbar radiculopathy: a pilot study of the natural history. Radiology. 1995;195:429-35.

Saal JA, Saal JS, Herzog RJ. The natural history of lumbar intervertebral disc extrusions is treated nonoperatively. Spine. 1990;15:683-6.

Cribb GL, Jaffray DC, Cassar-Pullicino VN. Observations on the natural history of massive lumbar disc herniation. J Bone Joint Surg Br. 2007;89:782-4.

Guinto FC, Hashim H, Stumer M. CT demonstration of disk regression after conservative therapy. AJNR Am J Neuroradiol. 1984;5:632-3.

Teplick JG, Haskin ME. Spontaneous regression of herniated nucleus pulposus. Am J Roentgenol. 1985;145:371-5.

Busk K, Cowan N, Katz DE, Gishen P. The natural history of sciatica associated with disc pathology. A prospective study with clinical and independent radiologic follow-up. Spine. 1992;17:1205-12.

Maigne JY, Rime B, Deligne B. Computed tomographic follow-up study of forty-eight cases of nonoperatively treated lumbar intervertebral disc herniation. Spine. 1992;17:1071-4.

Ejeskar A, Nachemson A, Herbert P. Surgery versus chemonucleolysis forherniated lumber disc. Clin Orthop Relat Res. 1982;171;252-9.






Original Research Articles