title: Spontaneous regression of sequestrated lumbar disc herniations: Literature review.
abstract: Lumbar disc herniations (LDH) may regress with conservative management; however, this phenomenon is poorly understood for the sequestrated subtype of LDH. We present one of the first comprehensive literature reviews specifically addressing the spontaneous regression of sequestrated intervertebral discs. We reviewed all publications with lumbar disc herniations, sequestrated subtype. Our results were then narrowed to patients who experienced spontaneous regression of the sequestration. Based on our literature review of 53 cases, patients with sequestrated lumbar disc herniations experienced symptomatic resolution in a mean of 1.33±1.34 months and radiographic resolution in 9.27±13.32 months. Symptomatic patients with sequestrated discs present similarly to those with other types of lumbar disc herniations. Sequestrations may have the highest likelihood to radiographically regress in the shortest time frame in comparison to the remaining subtypes of LDH. The most likely mechanism for regression is an inflammatory response elicited against the free fragment. Patients with disc sequestrations may be managed conservatively, in the absence of intractable pain, inability to walk, weakness or symptoms suggestive of cauda equina syndrome.
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA; Johns Hopkins Biomechanics and Surgical Outcomes Laboratory, Baltimore, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Macki
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA; Johns Hopkins Biomechanics and Surgical Outcomes Laboratory, Baltimore, USA.
authors.forename: Marta
authors.initials: M
authors.lastname: Hernandez-Hermann
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA; Johns Hopkins Biomechanics and Surgical Outcomes Laboratory, Baltimore, USA.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Bydon
authors.affiliation: Johns Hopkins Biomechanics and Surgical Outcomes Laboratory, Baltimore, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Gokaslan
authors.affiliation: Johns Hopkins Biomechanics and Surgical Outcomes Laboratory, Baltimore, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: McGovern
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA; Johns Hopkins Biomechanics and Surgical Outcomes Laboratory, Baltimore, USA. Electronic address: abydon1@jhmi.edu.
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
mesh_terms: D000328:Adult; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008297:Male; D011859:Radiography; D012075:Remission, Spontaneous
keywords: Disc; Herniation; Lumbar; Regression; Sequestrated