A Rare Case of Near Complete Regression of a Large Cervical Disc Herniation without Any Intervention Demonstrated on MRI

There are very few reported cases of regression of large cervical disc herniation without any intervention—the so-called spontaneous regression, demonstrated using MRI. We report a rare and interesting case of MRI that demonstrated near complete regression of a large herniated cervical intervertebral disc, without any surgical treatment. 1. Introduction Spontaneous regression of intervertebral disc herniation is more common in the lumbar region and very rare in the thoracic region, and although relatively rare in the cervical region, it is increasingly being reported in the literature [1–6]. In most cases, the disc herniation is associated with radiculopathy. Myelopathy is present in some of the cases with large cervical disc herniation compressing the cord. We present a rare case of MRI demonstration of significant regression of a large cervical disc herniation without any surgical treatment presenting with neck pain and right radiculopathy. 2. Case Material A 29-year-old male was referred to the radiology department of our institution for radiographs and then MRI of the cervical spine. He complained of severe neck pain associated with tingling and numbness in the right upper extremity. He did not give any history of trauma. His neurological assessment was within normal limits. The plain radiographs of the cervical spine revealed no significant abnormality. However, MRI revealed a large posterior disc extrusion (herniation) at the C5-C6 intervertebral level in the right paracentral location. The extruded disc was seen to be compromising the right lateral recess and indenting the cervical spinal cord and the exiting right C6 root. The other intervertebral disc spaces in view, were normal (Figures 1(a), 1(b), 1(c), and 1(d)). He was recommended for an anterior discectomy by the treating physician. The patient, however, was not willing to undergo surgery. Symptomatic treatment was given in the form of anti-inflammatory drugs, painkillers, and a muscle relaxant for almost a month and was advised to wear a cervical collar. The patient also received multiple sessions of physiotherapy. Within three to four months of symptomatic management, the patient reported significant improvement in his symptoms. The follow-up MRI done five months after the first one revealed significant regression of the C5-C6 disc extrusion (Figures 2(a), 2(b), 2(c), and 2(d)). Figure 1: Sagittal T2-weighted (a), sagittal T1-weighted (b), axial T2* (c), and axial T2-weighted (d) MRI images show a large cranially and caudally migrating posterior disc extrusion (herniation) at C5-C6 level