Resorption of herniated intervertebral disc. Phenomenon of transient increase in size

A.M. Tkachev^1,2, A.V. Epifanov², E.S. Akarachkova³, A.V. Smirnova⁴, A.V. Ilyushin¹, I.E. Gordeeva^1,5

¹Tkachev Clinic, Volgograd

²Tkachev Epifanov Clinic, Moscow

³International Society "Stress under Control", Moscow

⁴Medical Institute named after Berezin Sergey, St. Petersburg

⁵Volgograd State Medical University, Volgograd

Background: conservative treatment of herniated intervertebral discs (HID) is commonly accompanied by a decrease in their size, which is called HID resorption. Currently, it has been revealed that a transient size increase can accompany the process of HID resorption. However, there is no data on this phenomenon frequency and its role in the resorption process.

Aim: to determine the frequency of pseudoprogression or transient size increase of HID and to determine its role in the process of HID resorption.

Patients and Methods: the study included 327 patients aged 43.2±9.4 years with herniated lumbar and cervical disc who underwent conservative physical therapy. Patients had a decrease in HID size by over 50%. All patients underwent from 3 to 9 MRI scans, depending on the rate of HID resorption. The follow-up period ranged from 1.5 to 18 months.

Results: in 285 (87.1%) patients, there was a transient size increase of the hernia tissue, which was accompanied by a signal amplification on T2-weighted pulse sequences in the period from 2 to 5 months (3.4±0.9 months) in 266 (81.3%) cases, after which a subsequent decrease in the HID size occurred. In 233 (71.2%) cases, there was an increase in the signal from HID. In 195 (59.6%) patients, partial restoration of the intervertebral disc height was noted. An improvement in vertebral column statics accompanied HID resorption in 85 (25.9%) patients.

Conclusion: a transient size increase of HID is a pseudoprogression phenomenon observed  during HID resorption. It can be a positive prognostic marker and should be considered as a presumable predictor of the HID resorption onset.

Keywords: herniated intervertebral disc, resorption, pseudoprogression, phenomenon of transient size increase.

For citation: Tkachev A.M., Epifanov A.V., Akarachkova E.S. et al. Resorption of herniated intervertebral disc. Phenomenon of transient increase in size. RMJ. 2022;4:7–10.