title: Immediate Postoperative Reversal of Disc Herniation Following Facetal Distraction-Fixation Surgery: Report of 4 Cases.
abstract: BACKGROUND
  We report cases of 4 patients where Goel facet distraction surgery resulted in restoration of herniated disc back into the intervertebral disc space in the immediate postoperative period. Such a fate of herniated disc has not been recorded earlier.
  
  
  METHODS
  During the period 2010 to 2011, 4 patients with single level 'contained' herniated disc that extended to the posterior surface of adjoining vertebral bodies and resulted in severe cord and root compression were surgically treated. The posterior longitudinal ligament was essentially intact in all 4 cases. Surgery involved facetal distraction technique using Goel facet spacers as a standalone method of treatment.
  
  
  RESULTS
  Immediate postoperative imaging showed nearly complete disappearance of the disc bulge, restoration of the cervical cord girth and distraction-fixation arthrodesis of the spinal segment. All patients had remarkable and sustained clinical improvement. At a 5-year follow-up, all 4 patients were well and showed no evidence of recurrent symptoms or recurrence of herniated disc-related imaging findings.
  
  
  CONCLUSIONS
  The indications for facetal distraction surgery, its mechanisms of action and its suitability in the presented cases are discussed.
authors.affiliation: Department of Neurosurgery, King Edward VII Memorial Hospital and Seth G.S. Medical College, Parel, Mumbai, India. Electronic address: atulgoel62@hotmail.com.
authors.forename: Atul
authors.initials: A
authors.lastname: Goel
authors.affiliation: Department of Neurosurgery, King Edward VII Memorial Hospital and Seth G.S. Medical College, Parel, Mumbai, India.
authors.forename: Abhidha
authors.initials: A
authors.lastname: Shah
authors.affiliation: Department of Neurosurgery, King Edward VII Memorial Hospital and Seth G.S. Medical College, Parel, Mumbai, India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Patni
authors.affiliation: Department of Neurosurgery, King Edward VII Memorial Hospital and Seth G.S. Medical College, Parel, Mumbai, India.
authors.forename: Raghvendra
authors.initials: R
authors.lastname: Ramdasi
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy / Q000379:methods; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019857:Osteogenesis, Distraction / Q000295:instrumentation / Q000379:methods*; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome
keywords: Cervical spondylosis; Facet distraction-arthrodesis; Goel facet spacer; Intervertebral disc