Can intensive conservative treatment reverse chronic cervical disc herniation? A preregistered case study with complete MRI-documented resolution

The prognosis for regression of cervical disc herniation (CDH) in chronic cases (>15 weeks) is poor. Non-surgical spinal decompression (NSSD) has shown promise in preliminary studies, but evidence for its effect on structural disc changes remains limited. This case study represents the partial replication of an intensive 6-month conservative treatment program. A 44-year-old male with a 7 mm C6-7 disc extrusion and 12 months of radiculopathy symptoms underwent a preregistered 6-month treatment protocol combining home-based NSSD, epidural steroid injection, and intensive physical therapy. Structural outcomes were assessed using pre- and post-treatment MRI with quantitative analysis using the modified disc herniation index (mDHI). Complete resolution of the C6-7 disc extrusion was observed, with mDHI decreasing from 0.405 to 0 (100% reduction). Severe left neuroforaminal narrowing resolved to moderate. Additionally, spinal cord effects of disc bulges at adjacent levels (C4-5 and C5-6) showed some improvement. This preregistered case study documents complete resolution of a chronic cervical disc extrusion in the context of intensive conservative treatment. The degree of reduction exceeded that reported in a prior NSSD case series (32–55% reduction). While causation cannot be established from a single case, this observation supports further investigation of intensive conservative protocols for chronic CDH.