腰椎间盘突出的重吸收(新英格兰杂志)

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T h e ne w engl a nd jour na l o f medicine

n engl j med 374;16 April 21, 2016

1564

I mages in Clinical Medicine A 29-year-old woman presented to the spine clinic with new-onset pain in her right leg, accompanied by paresthesia. There were no bowel or bladder symptoms. Magnetic resonance imaging (MRI) of the lum-bar spine revealed a lumbar disk herniation resulting in substantial spinal stenosis and nerve-root compression (Panel A, arrow). She elected conservative treatment with physical therapy and an epidural injection of glucocorticoids. A second MRI obtained at follow-up 5 months after presentation showed resolution of the hernia-tion (Panel B, arrow). Lumbar disk herniation has an uncertain natural history. Data from clinical trials suggest that patients who have herniated lumbar disks have similar long-term outcomes whether they undergo surgery or elect conservative management. In addition, the risk of subsequent catastrophic worsening without surgery is minimal. This patient reported that she began to have back pain after playing vol-leyball several years before presentation, whereas the pain and paresthesia in her leg began 6 months earlier and were not associated with a precipitating event. Her clinical symptoms resolved, and she was discharged from the clinic, with follow-up recommended as needed.

DOI: 10.1056/NEJMicm1511194

Perry A. Ball, M.D.

Dartmouth–Hitchcock Medical Center

Lebanon, NH

jennifer .h ong@h itchcock .o rg A B

Lindsey R. Baden, M.D., Editor

Resolution of Lumbar Disk Herniation without Surgery

The New England Journal of Medicine

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