Lumbar disc herniation (LDH) is a common spinal condition where the fibrous annulus of the intervertebral disc ruptures, causing the nucleus pulposus to herniate and compress the spinal nerve and cauda equina, leading to pain and neurological dysfunction . As the proportion of LDH patients increases, understanding the pathogenesis and factors influencing natural absorption becomes crucial for clinicians in choosing appropriate treatment options. This article aims to provide a comprehensive overview of LDH, focusing on its characteristics, mechanisms of resorption, and potential clinical treatments for promoting reabsorption.
I. Characteristics of Lumbar Disc Herniation
LDH typically presents with clinical symptoms such as pain and neurological dysfunction. Accurate diagnosis is crucial for targeted treatment, and the most effective imaging method for diagnosing disc herniation is magnetic resonance imaging (MRI).
II. Mechanisms of Resorption in Lumbar Disc Herniation
Recent research has shed light on the phenomenon of spontaneous resorption of LDH without surgical intervention. Macrophage infiltration, inflammatory responses, matrix remodeling, and neovascularization play vital roles in the biological mechanisms involved in the resorption process.
Macrophage Infiltration: Macrophages are crucial immune cells that can regulate inflammatory mediators and promote tissue repair. Studies have shown that macrophage infiltration in the intervertebral disc is essential for the spontaneous reabsorption of LDH.
Inflammatory Responses: Inflammatory processes within the herniated disc contribute to the resorption mechanism. Various inflammatory mediators and cytokines participate in this process.
Matrix Remodeling: The extracellular matrix in the intervertebral disc undergoes remodeling during the resorption process. Matrix metalloproteinases (MMPs) play a key role in breaking down the matrix, allowing for disc reabsorption.
Neovascularization: The formation of new blood vessels, known as neovascularization, is associated with the resorption of herniated discs. Neovascularization is a critical process for the supply of nutrients and oxygen during disc healing.
III. Potential Clinical Treatments for Promoting Reabsorption
Conservative treatment is the preferred option for most newly diagnosed LDH patients. Various approaches can be used, such as bed rest, drug therapy, exercise therapy, epidural injection, lumbar traction, and traditional Chinese medicine treatment.
Traditional Korean Medical Treatment: A 10-year observational study conducted in Korea showed that nonsurgical traditional Korean medical treatment produced beneficial long-term effects for LDH patients, with reduced pain and improved disability maintained over the 10-year period.
Lumbar disc herniation is a common spinal condition that can cause significant pain and neurological dysfunction. Understanding the mechanisms of resorption and factors influencing natural absorption is essential for clinicians to make informed decisions regarding treatment options. Macrophage infiltration, inflammatory responses, matrix remodeling, and neovascularization are crucial biological mechanisms involved in the resorption process. Conservative treatments, including traditional Korean medical treatment, have shown promising long-term effects for LDH patients. However, large-scale randomized controlled trials are needed to further validate the effectiveness of these treatments.