A meta-analysis of the incidence of resorption of lumbar disc herniation_West China Medical Journal

Authors：

WANG Yi ¹ , JIANG Ling ² ,  DAI Guogang ¹ , LI Lengtao ³ , WANG Lanjie ¹

1. Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan 610041, P. R. China;
2. College Hospital, Sichuan Agricultural University-Chengdu Campus, Chengdu, Sichuan 611130, P. R. China;
3. School of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

DAI Guogang, Email: guogang_dai@hotmail.com

Keywords：

Lumbar disc herniation; resorption; incidence; meta-analysis

DOI：

10.7507/1002-0179.202004355

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Objective To comprehensively investigate the incidence of resorption of lumbar disc herniation, and provide reference data for clinical decision-making. Methods Seven electronic databases (PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, Wangfang data and Chongqing VIP database) were searched for relevant studies that might have reported morphologic changes in lumbar disc herniation when reporting the follow-up results of patients with lumbar disc herniation treated non-surgically from inception to March, 2020. Articles were screened according to inclusion and exclusion criteria, and the total number of patients, number of patients with resorption, and other important data were extracted for analysis. Random effect models were used for meta-analysis, and subgroup analysis, sensitivity analysis, meta-regression analysis, and Egger’s test were performed. Results A total of 15712 articles were identified from these databases, and 48 were eligible for analysis. A total of 2880 non-surgically treated patients with lumbar disc herniation were included in the meta-analysis, 1740 of whom presented resorption. Meta-analysis revealed that the incidence of resorption was 0.60 [95% confidence interval (CI) (0.46, 0.72)]. In subgroup analyses, studies that quantitatively measured the resorption of lumbar disc herniation yielded statistically higher pooled incidence [0.73, 95%CI (0.60, 0.85)] than those that used qualitative methods [0.51, 95%CI (0.34, 0.69)] (P=0.0252). The pooled incidence gradually increased in randomized controlled trials (RCTs) [0.50, 95%CI (0.15, 0.85)], non-RCT prospective studies [0.59, 95%CI (0.48, 0.70)] and retrospective studies [0.69, 95%CI (0.36, 0.95)], but the difference was not statistically significant (P=0.7523). The pooled incidence varied from 0.58 [95%CI (0.54, 0.71)] to 0.62 [95%CI (0.49, 0.74)] after the sequential omission of each single study. There was no significant change in the pooled incidence [0.62, 95%CI (0.43, 0.79)] when only low-risk RCTs and high-quality non-RCT studies were included, comparing with original meta-analysis results. Meta-regression showed that measurements partially caused heterogeneity (R²=15.34%, P=0.0858). Egger’s test suggested that there was no publication bias (P=0.4622). Conclusions According to current research, there is an overall incidence of resorption of 60% [95%CI (46%, 72%)] among non-surgically treated patients with lumbar disc herniation. The probability of resorption should be fully considered before making a decision on surgery.

Citation： WANG Yi, JIANG Ling, DAI Guogang, LI Lengtao, WANG Lanjie. A meta-analysis of the incidence of resorption of lumbar disc herniation. West China Medical Journal, 2022, 37(8): 1221-1230. doi: 10.7507/1002-0179.202004355 Copy

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1. Stafford MA, Peng P, Hill DA. Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. Br J Anaesth, 2007, 99(4): 461-473.
2. Ramaswami R, Ghogawala Z, Weinstein JN. Management of sciatica. N Engl J Med, 2017, 376(12): 1175-1177.
3. Peul WC, Van Houwelingen HC, Van Den Hout WB, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med, 2007, 356(22): 2245-2256.
4. Peul WC, Van Den Hout WB, Brand R, et al. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial. BMJ, 2008, 336(7657): 1355-1358.
5. Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA, 2006, 296(20): 2451-2459.
6. Shriver MF, Xie JJ, Tye EY, et al. Lumbar microdiscectomy complication rates: a systematic review and meta-analysis. Neurosurg Focus, 2015, 39(4): E6.
7. Guinto FC Jr, Hashim H, Stumer M. CT demonstration of disk regression after conservative therapy. AJNR Am J Neuroradiol, 1984, 5(5): 632-633.
8. Teplick JG, Haskin ME. Spontaneous regression of herniated nucleus pulposus. AJR Am J Roentgenol, 1985, 145(2): 371-375.
9. 郭志英, 王穎, 苗芙蓉, 等. 腰椎間盤突出癥康復治療前后 CT 檢查對比分析. 中國康復醫學雜志, 1987(3): 102-104.
10. Bozzao A, Gallucci M, Masciocchi C, et al. Lumbar disk herniation: Mr imaging assessment of natural history in patients treated without surgery. Radiology, 1992, 185(1): 135-141.
11. Bush K, Cowan N, Katz DE, et al. The natural history of sciatica associated with disc pathology. A prospective study with clinical and independent radiologic follow-up. Spine (Phila Pa 1976), 1992, 17(10): 1205-1212.
12. Delauche-Cavallier MC, Budet C, Laredo JD, et al. Lumbar disc herniation. Computed tomography scan changes after conservative treatment of nerve root compression. Spine (Phila Pa 1976), 1992, 17(8): 927-933.
13. Ellenberg MR, Ross ML, Honet JC, et al. Prospective evaluation of the course of disc herniations in patients with proven radiculopathy. Arch Phys Med Rehabil, 1993, 74(1): 3-8.
14. Ilkko E, L?hde S, Heikkinen ER. Late CT-findings in non-surgically treated lumbar disc herniations. Eur J Radiol, 1993, 16(3): 186-189.
15. Komori H, Shinomiya K, Nakai O, et al. The natural history of herniated nucleus pulposus with radiculopathy. Spine (Phila Pa 1976), 1996, 21(2): 225-229.
16. Yukawa Y, Kato F, Matsubara Y, et al. Serial magnetic resonance imaging follow-up study of lumbar disc herniation conservatively treated for average 30 months: relation between reduction of herniation and degeneration of disc. J Spinal Disord, 1996, 9(3): 251-256.
17. 岳壽偉, 黃麗雯, 馮德朝, 等. 腰椎間盤突出癥快速牽引后 CT 隨訪觀察. 中華理療雜志, 1997, 20(3): 157-160.
18. Ahn SH, Ahn MW, Byun WM. Effect of the transligamentous extension of lumbar disc herniations on their regression and the clinical outcome of sciatica. Spine (Phila Pa 1976), 2000, 25(4): 475-480.
19. 韓永珍, 姚馥蘭, 陳菊春, 等. 腰椎間盤突出癥的物理治療及 CT 隨訪復查. 頸腰痛雜志, 2000, 21(3): 237-238.
20. 王曉玉, 郭淑紅, 侯毅鞠, 等. 推拿六法治療腰椎間盤突出癥. 現代康復, 2000, 4(7): 1006-1007.
21. 余潤明, 陶文, 孫安達, 等. 牽引推拿復位術治療中央型腰椎間盤突出癥的臨床研究. 山東中醫藥大學學報, 2000, 24(6): 425-427.
22. Takada E, Takahashi M, Shimada K. Natural history of lumbar disc hernia with radicular leg pain: spontaneous MRI changes of the herniated mass and correlation with clinical outcome. J Orthop Surg (Hong Kong), 2001, 9(1): 1-7.
23. Buttermann GR. Lumbar disc herniation regression after successful epidural steroid injection. J Spinal Disord Tech, 2002, 15(6): 469-476.
24. Henmi T, Sairyo K, Nakano S, et al. Natural history of extruded lumbar intervertebral disc herniation. J Med Invest, 2002, 49(1/2): 40-43.
25. Autio RA, Karppinen J, Niinim?ki J, et al. Determinants of spontaneous resorption of intervertebral disc herniations. Spine (Phila Pa 1976), 2006, 31(11): 1247-1252.
26. Jensen TS, Albert HB, Soerensen JS, et al. Natural course of disc morphology in patients with sciatica: an MRI study using a standardized qualitative classification system. Spine (Phila Pa 1976), 2006, 31(14): 1605-1612.
27. Ozturk B, Gunduz OH, Ozoran K, et al. Effect of continuous lumbar traction on the size of herniated disc material in lumbar disc herniation. Rheumatol Int, 2006, 26(7): 622-626.
28. Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J, 2006, 6(2): 131-137.
29. 王永東, 畢素清, 王國強, 等. 腰椎間盤突出能否還納復位的臨床分析. 頸腰痛雜志, 2006, 27(4): 275-276.
30. Cribb GL, Jaffray DC, Cassar-Pullicino VN. Observations on the natural history of massive lumbar disc herniation. J Bone Joint Surg Br, 2007, 89(6): 782-784.
31. Broetz D, Hahn U, Maschke E, et al. Lumbar disk prolapse: response to mechanical physiotherapy in the absence of changes in magnetic resonance imaging. Report of 11 cases. NeuroRehabilitation, 2008, 23(3): 289-294.
32. 徐濤, 楊忠華, 王霖. 針藥并用治療腰椎間盤突出癥 56 例臨床觀察. 新中醫, 2009, 41(12): 86-88.
33. Iwabuchi M, Murakami K, Ara F, et al. The predictive factors for the resorption of a lumbar disc herniation on plain MRI. Fukushima J Med Sci, 2010, 56(2): 91-97.
34. Kamanli A, Karaca-Acet G, Kaya A, et al. Conventional physical therapy with lumbar traction; clinical evaluation and magnetic resonance imaging for lumbar disc herniation. Bratisl Lek Listy, 2010, 111(10): 541-544.
35. 劉建興, 張曉陽, 徐俊. 腰椎間盤突出自然演變的 MRI 觀察. 廣東醫學, 2010, 31(5): 576-577.
36. 劉錦濤, 姜宏, 徐坤林, 等. 非手術療法對腰椎間盤突出后重吸收的影響(附 30 例分析). 中國骨與關節損傷雜志, 2010, 25(11): 978-980.
37. 鄭壽鵬, 尼哈提. 鹿瓜多肽與甲鈷胺聯合治療腰椎間盤突出癥的臨床觀察. 中國醫藥, 2010, 5(2): 160-161.
38. 葛恒清. 針刀治療對促進腰椎間盤突出后自然吸收現象的臨床觀察. 世界中醫藥, 2011, 6(6): 506-507.
39. 孟彩云. 腰椎間盤突出后自然吸收(針刀療法)的療效觀察及護理分析. 中國中醫藥現代遠程教育, 2011, 9(16): 42-43.
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West China Medical Journal

A meta-analysis of the incidence of resorption of lumbar disc herniation

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