Clinical Outcomes and Factors Associated with Radiological Resorption in Symptomatic Extruded or Sequestrated Lumbar Disc Herniation: A Retrospective Cohort Study
In brief
Lumbar disc resorption was linked to surgery rates of 0.8% vs 24%
In this retrospective cohort of 578 nonsurgically treated patients, 44% had at least partial disc resorption, typically documented after 8.2 months. Those patients had fewer surgeries and symptomatic episodes, with greater improvement in pain and disability after six months, but improvement also occurred without resorption, and the amount of resorption did not consistently predict outcomes.
- Journal
- The spine journal : official journal of the North American Spine Society (Q1)
- Published
- 22 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Zhenyu Tang, Xiaorong Li, Chengpeng Gong, Zihang Li, Kaiyang Xu, Zhijia Ma, et al.
- PMID
- 42913949
- DOI
- 10.1016/j.spinee.2026.10.013
Why clinicians should know about it
- Picked for Spine Surgery (paper of the day, 25 October 2026): Nonsurgical disc herniation outcomes inform operative decision-making alternatives
Abstract
BACKGROUND: The relationship between resorption and long-term outcomes in extruded or sequestrated lumbar disc herniation (LDH) remains uncertain. PURPOSE: To evaluate the clinical significance of resorption and factors associated with resorption timing. STUDY DESIGN: Single-center retrospective cohort study. PATIENT SAMPLE: 578 patients with symptomatic extruded or sequestrated LDH were managed nonsurgically and followed for ≥ 24 months. OUTCOME MEASURES: Surgery, symptomatic episodes, Oswestry Disability Index (ODI), visual analog scale (VAS), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). METHODS: Radiological resorption was defined as ≥30% volume reduction, representing at least partial resorption. Generalized estimating equations assessed longitudinal outcomes; time-dependent Cox and landmark analyses assessed surgery; and an interval-censored model assessed resorption timing. Governmental and institutional grants provided US$100,001-500,000. No conflict-of-interest bias was identified. RESULTS: Resorption was documented in 256 patients (44.3%; median, 8.2 months). Surgery occurred in 0.8% versus 24.0%; resorption was associated with lower surgical risk (adjusted HR, 0.067; 95% CI, 0.015-0.292), with consistent landmark findings. The resorption group had fewer symptomatic episodes. ODI and VAS improvement was similar through 6 months but greater thereafter; HADS-A improvement was greater throughout. Komori type III (HR, 6.07; 95% CI, 3.58-10.29) and Modic type I (HR, 2.65; 95% CI, 1.25-5.60) were associated with earlier resorption. Resorption magnitude showed no consistent association with outcomes. CONCLUSIONS: Resorption was associated with a more favorable clinical course, but improvement also occurred without resorption. Komori type III and Modic type I were associated with earlier documented resorption; resorption magnitude showed no consistent outcome association.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.