Immediate Postoperative Reversal of Disc Herniation Following Facetal Distraction-Fixation Surgery: Report of 4 Cases

BACKGROUND: We report cases of 4 patients where Goel facet distraction surgery resulted in restoration of herniated disc back into the intervertebral disc space in the immediate postoperative period. Such a fate of herniated disc has not been recorded earlier. METHODS: During the period 2010 to 2011, 4 patients with single level 'contained' herniated disc that extended to the posterior surface of adjoining vertebral bodies and resulted in severe cord and root compression were surgically treated. The posterior longitudinal ligament was essentially intact in all 4 cases. Surgery involved facetal distraction technique using Goel facet spacers as a standalone method of treatment. RESULTS: Immediate postoperative imaging showed nearly complete disappearance of the disc bulge, restoration of the cervical cord girth and distraction-fixation arthrodesis of the spinal segment. All patients had remarkable and sustained clinical improvement. At a 5-year follow-up, all 4 patients were well and showed no evidence of recurrent symptoms or recurrence of herniated disc-related imaging findings. CONCLUSIONS: The indications for facetal distraction surgery, its mechanisms of action and its suitability in the presented cases are discussed.