Serial MRI documentation of sequestrated lumbar disc resorption during conservative management: a case report.

Abstract

Background: Although spontaneous resorption in lumbar disc herniation (LDH) is a recognized phenomenon, systematic visual evidence of its temporal progression remains limited. This report utilizes short-interval serial magnetic resonance imaging (MRI) to document the longitudinal clinico-radiological evolution of a sequestrated LDH managed within an integrative conservative framework, providing a continuous imaging-clinical timeline linking structural resolution to symptomatic recovery.

Case presentation: A 33-year-old man presented with acute-onset low back pain and right lower limb radicular pain. MRI demonstrated a right posterolateral L4/5 disc extrusion with sequestration, featuring peripheral contrast enhancement (the "bull's-eye" sign). After declining non-steroidal anti-inflammatory drugs (NSAIDs), the patient opted for a 16-week integrative regimen comprising acupuncture and modified Duhuo Jisheng decoction. Serial MRI across five time points enabled high-resolution longitudinal tracking of morphological changes. Imaging documented the complete resorption of the free sequestrated fragment, achieving a 79.3% reduction in the herniation ratio alongside a 77.7% reduction in the cross-sectional area at 4 months. These morphological adjustments coincided with substantial clinical recovery, with the Visual Analogue Scale (VAS) score decreasing from 8 to 0 and the Japanese Orthopaedic Association (JOA) score improving from 5 to 28. A 5-month post-treatment follow-up confirmed sustained resolution without recurrence, showing only residual L4/5 disc bulging.

Conclusions: Serial MRI dynamically captured the progressive resorption of a sequestrated L4/5 disc and its concordant clinical recovery during integrative conservative management. While this approach was temporally associated with favorable outcomes, the observational design precludes definitive causal attribution. This report suggests that such management may provide a supportive clinical window allowing spontaneous resorption to proceed; however, higher-level controlled studies are required to differentiate potential therapeutic modulation from the natural history of disc regression.