Yes. Many lumbar disc herniations shrink without surgery, and the larger, more displaced ones are the most likely to. In a systematic review, 96% of sequestrated herniations and 70% of extrusions regressed. That runs against what most patients expect when they see a large herniation on an MRI after a car accident, and it is one of the first things I tell patients in Charlotte.
Regression Rates by Type
A systematic review included patients with lumbar disc herniation treated without surgery and imaged at least twice (Chiu, Clin Rehabil 2015). Of 31 studies meeting its criteria, nine used the standard herniation classification and were pooled to estimate regression by type. Regression occurred in 96% of sequestrations, 70% of extrusions, 41% of protrusions, and 13% of bulges. Complete resolution occurred in 43% of sequestrated discs and 15% of extruded discs.
What the Types Mean
Under the standard nomenclature, a bulge involves more than 25% of the disc circumference. A protrusion is a focal herniation with a base wider than the displaced material. An extrusion is wider than its base or extends above or below the disc. A sequestration has separated from the disc (Fardon, Spine J 2014). The more the material is displaced, the more likely it was to regress in this review.
Shrinking and Feeling Better Are Different
This review measured what happened on imaging. It did not measure pain or function. Symptoms can improve before a herniation shrinks, and a herniation can shrink while symptoms persist. A follow-up MRI that shows regression is good news, but it is not the measure of recovery.
Clinical recovery data come from other studies. In a randomized trial of 283 patients with sciatica, 95% reported recovery at one year whether they had early surgery or prolonged conservative care with surgery if needed, and 61% of the conservative group did not have surgery during that year (Peul, N Engl J Med 2007).
What This Means After a Car Accident
A large herniation on a post-crash MRI is not a sentence to surgery. For a patient without red flags such as progressive weakness or loss of bladder or bowel control, monitoring with conservative care is reasonable, and the imaging data suggest the herniation itself has a good chance of shrinking. For a future care estimate, a recommendation for surgery should rest on the patient's course and findings, not on the size of the herniation on the first MRI.
For an example of how post-collision imaging findings and outcomes are documented in the peer-reviewed literature, read Dr. Justin Dick's published case report on refractory lumbar pain following a motor vehicle accident in a geriatric patient.
Frequently Asked Questions
Can a herniated disc go away on its own?
Many shrink. A systematic review found regression in 96% of sequestrations, 70% of extrusions, 41% of protrusions, and 13% of bulges (Chiu, Clin Rehabil 2015).
Are larger herniations more likely to shrink?
Yes. Extrusions and sequestrations were significantly more likely to regress than bulges or protrusions in the systematic review.
How often does a herniated disc disappear completely?
Complete resolution occurred in 43% of sequestrated discs and 15% of extruded discs (Chiu, Clin Rehabil 2015).
Does a shrinking herniation mean I am recovered?
Not necessarily. The review measured imaging, not pain. Symptoms and imaging do not always change together.
How does Dr. Justin Dick manage a large herniation after a car accident?
Dr. Justin Dick in Charlotte, NC monitors neurologic findings with conservative care when there are no red flags and coordinates surgical consultation when pain is severe, progressive, or not improving.
Where can I get a herniated disc evaluated after a car accident in Charlotte, NC?
Dr. Justin Dick, DC, CNMT, ARRT(N)(CT), sees car accident patients at Clear Life Scoliosis and Chiropractic Center, 8814 Rachel Freeman Way, Suite 103, Charlotte, NC 28278, phone 980-368-0766. Personal injury patients are treated on a lien basis, with no out-of-pocket payment at the time of care.
Sources and Evidence Tiers
- Chiu CC, Chuang TY, Chang KH, Wu CH, Lin PW, Hsu WY. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil. 2015;29(2):184-195. PMID 25009200. LinkEvidence tier: Systematic review
- Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Lumbar disc nomenclature: version 2.0. Spine J. 2014;14(11):2525-2545. PMID 24768732. LinkEvidence tier: Expert consensus (NASS, ASSR, ASNR task forces)
- Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356(22):2245-2256. PMID 17538084. LinkEvidence tier: Randomized controlled trial (283 patients)
About the author. Dr. Justin M. Dick, DC, is the owner and treating clinician at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. He holds dual imaging credentials as a Certified Nuclear Medicine Technologist (CNMT) and as an ARRT-registered technologist in nuclear medicine and CT, ARRT(N)(CT). He is a Senior Fellow of the CLEAR Institute, holds the ISICO World Masters credential, is a SOSORT provisional member, and is a certified DOT medical examiner on the FMCSA National Registry. He has multiple peer-reviewed publications indexed in PubMed and serves as adjunct faculty at Life, Sherman, and Palmer chiropractic colleges.
Service Area
Clear Life Scoliosis and Chiropractic Center sees personal injury and spinal imaging patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, and Fort Mill SC.
Related Pages
- Personal injury and car accident spinal care in Charlotte
- Dr. Justin Dick's research
- Case report: refractory lumbar pain after a motor vehicle accident
- Research and evidence at Clear Life
- Questions and answers
- Our team
- Press
- Book your evaluation
- Contact Clear Life
Clear Life Scoliosis and Chiropractic Center
8814 Rachel Freeman Way, Suite 103
Charlotte, NC 28278
Phone: 980-368-0766
Email: office@clearlifescoliosis.com
Book online
Justin Dick
Contact Me
