Spontaneous Regression of a Cervical Disc Herniation: A Case Report

Abstract Background and purpose: The purpose of this report is to highlight a case of a cervical disc herniation and spinal cord compression that regressed spontaneously following conservative treatment. The natural history and positive likelihood of spontaneous regression of disc herniation in the lumbar spine have been well documented.1,5.6However, the clinical course of cervical disc herniation remains poorly established.2-4Due to the concern for spinal cord injury, patients with signs of cord compression are often referred for surgery.3This case, along with others mentioned in the literature, suggests the possibility of disc regression and symptom improvement with conservative treatment. Case Information: The patient was a 34-year-old female who presented to her primary care physician with nontraumatic onset of neck pain and right upper extremity tingling and pain one month prior. Magnetic resonance imaging (MRI) of the cervical spine revealed a four-millimeter, paracentral disc extrusion at C6-7 with migration to the body of C7 and spinal cord flattening. The patient was referred to a neurosurgeon who recommended surgical intervention due to evidence of spinal cord compression and risk of myelopathy with future injury. The patient refused surgical intervention at that time. Following conservative treatment, an MRI performed six months later revealed spontaneous regression of the C6-7 herniation from four millimeters to two millimeters with no evidence of spinal cord compression. Right upper extremity symptoms resolved and neck pain significantly decreased, with the greatest improvement occurring in the first two months. Conclusions: In cases of cervical disc herniation with spinal cord compression, the treatment course historically favors surgical intervention; however this report reveals a case of cervical disc herniation with spinal cord compression that spontaneously regressed in six months resulting in resolution of upper extremity radicular symptoms. There are similar case reports in the literature, though only two known cases have been reported within the last ten years. Future studies should be designed to capture higher level evidence of the natural history of large cervical disc herniation with cord compression. References Chiu CC, Chuang TY, & Chang KW. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical Rehabilitation. 2014; 29(2), 184-195. Wong JJ, Cote P, Quesnele JJ, et al. The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature. The Spine Journal. 2014; 14(8),1781 – 1789. Pan H, Xiao LW, Hu QF. Spontaneous regression of herniated cervical disc fragments and its clinical significance. Orthopaedic Surgery. 2010; 2(1), 77-79. Kim SH, Park MY, Lee SM, et al. Acupuncture and spontaneous regression of a radiculopathic cervical herniated disc. Journal of Pharmacopuncture. 2012; 15(2): 36 – 39.