By: Alena Wiese
Summary: A September 2026 study in the European Spine Journal followed 60 people with very large extruded or sequestered lumbar disc herniations and found that 88.3 percent did not have surgery within two years under a conservative-first plan. For readers in Hamlin and Winter Garden holding an alarming radiology report, the research adds useful context, though not a promise.
A person sits in a parked car outside an imaging center, scrolling through a radiology report on a phone before any doctor has explained it. The phrases are hard to unsee: “large extrusion,” “sequestered fragment,” “narrowing of the canal.” A leg ache that started as a nuisance suddenly has a name, and the name sounds like it belongs in an operating room.
That reaction is understandable, and new research suggests it may be premature for many people. The short answer is that a large, even “giant,” herniation on MRI does not automatically mean surgery. In a prospective study published online Sept. 16, 2026, in the European Spine Journal, researchers followed 60 consecutive patients whose lumbar herniations met predefined criteria for giant extruded or sequestered disc material. Under a conservative-first plan, 53 of them (88.3 percent) did not have surgery within 24 months. Seven converted to surgery, a rate of 11.7 percent, all within the first six months, and the authors report that every conversion was elective rather than an emergency.
Studies like this one are what a clinician with three decades in practice, such as Dr. Jeffrey N. Shebovsky, DC, weighs alongside the one thing a scan cannot show: how a specific person’s nerves, strength, and daily life are responding.
What Do “Bulge,” “Protrusion,” “Extrusion,” And “Sequestration” Mean On An MRI?
They describe how far disc material has moved beyond its normal edge, from a broad, mild bulge to a piece that has broken away entirely. A bulge is a wide, shallow extension past the disc’s border; a protrusion is a more focal push; an extrusion reaches farther out, and a sequestration is a fragment that has separated from the parent disc.
What the words do not describe is pain. A 2015 systematic review in the American Journal of Neuroradiology, led by researchers at Mayo Clinic and the University of Washington, pooled 33 articles covering 3,110 people who had no back pain at all. Disc bulges appeared in 30 percent of 20-year-olds and 84 percent of 80-year-olds. Disc protrusions ranged from 29 percent to 43 percent across the same ages. The authors concluded that many imaging-based degenerative features may be part of normal aging.
Source: Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations, American Journal of Neuroradiology, April 2015.
Can A Large Herniated Disc Shrink On Its Own?
It can, and the new study measured how often large fragments got smaller over six months. The researchers used contrast-enhanced MRI, which can show a bright ring, called rim enhancement, around displaced disc material. That ring is thought to reflect blood vessel and inflammatory activity around the fragment, which is one proposed route by which the body may break down and absorb it.
Among patients with rim enhancement, the median herniation volume fell by 31.54 percent at six months. Among those without it, the median change was 0.00 percent, a difference the authors reported as statistically significant (P = 0.015). None of the 21 rim-enhancement patients converted to surgery, compared with 7 of 39 in the other group, but that difference did not reach statistical significance (P = 0.085), and the authors describe its value for predicting surgery as exploratory.
What Did The New Study Actually Test?
It tested whether a structured nonsurgical plan was feasible for people whose herniations looked severe on imaging but who had no emergency signs. “Giant” was defined as a sagittal protrusion ratio of 0.50 or greater, meaning the herniation occupied at least half the depth of the spinal canal on a side view.
Patients with cauda equina syndrome, progressive neurological deficit, severe motor impairment, prior surgery at the same level, infection, tumor, fracture or obvious spondylolisthesis were excluded. The plan combined an anti-inflammatory medication and a vitamin B12 compound, patient education, activity modification, and rehabilitation described as neurologically safe, with graded core training added after pain eased. On the Japanese Orthopaedic Association score, where higher is better, average results rose from 14.42 to 24.19 at 24 months. Oswestry Disability Index scores fell from 27.79 to 5.42.
Source: Lumbar disc herniation with giant extruded or sequestered morphology: feasibility of a conservative-first strategy and the stratification value of contrast-enhanced MRI, European Spine Journal, September 2026.
What Does This Study Not Tell Us?
It does not prove that conservative care caused the improvement, and it cannot say how these patients would have done with early surgery. The authors list the limits themselves: one center in China, 60 patients, only seven surgical conversions, no surgical comparison group, and follow-up MRI limited to patients who had not already converted, which may skew the volume findings. Sixteen patients also received additional Chinese medicine or acupuncture, the rim-enhancement classification has not been validated, and leg pain scores were incomplete.
It also should not swing readers to the opposite extreme of dismissing MRI findings. A second review from the same Mayo Clinic research group, published in December 2015, compared 3,097 people with and without back pain. In adults 50 and younger, disc extrusion was more common in people with pain (odds ratio 4.38), as were disc bulges (odds ratio 7.54). Imaging findings matter. They simply have to be matched to the exam.
Source: MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis, American Journal of Neuroradiology, December 2015.
When Is A Herniated Disc Not A Wait-And-See Situation?
Any loss of bladder or bowel control, numbness in the groin or inner thighs, or leg weakness that is getting worse calls for emergency or same-day medical care, not a conservative trial. The American Academy of Orthopaedic Surgeons describes loss of bladder or bowel control as a possible sign of cauda equina syndrome, a medical emergency. The new study excluded patients like these, so its numbers do not apply to them.
Where Does A Hamlin Chiropractic Evaluation Fit?
A careful evaluation comes before any plan, and its first job is to decide whether conservative care is appropriate at all. ReliefNow® Disc Joint & Nerve Center Hamlin, at 5736 Hamlin Groves Trail, Suite 154, Winter Garden, FL 34787 (407-706-4944), serves Hamlin, Horizon West, Winter Garden, and Windermere. The practice states on its page that every plan starts with an evaluation. Winter Garden alone had an estimated 48,063 residents as of July 2025, according to U.S. Census Bureau QuickFacts.
Dr. Shebovsky founded Orange Wellness in 1994 and holds Florida chiropractic license CH6499. He earned a B.S. in biology from the State University of New York at Albany and his Doctor of Chiropractic from New York Chiropractic College, graduating with honors, and completed postgraduate training in sports injuries, whiplash, and brain injury traumatology.
An evaluation of this kind typically compares the MRI wording against a neurological exam of reflexes, strength, and sensation, so a “sequestered fragment” is interpreted in light of how the nerve is actually functioning. When red flags or progressive weakness appear, the appropriate step is referral to a physician or spine surgeon. When conservative care is reasonable, progress can be measured with the same kinds of tools researchers use, including disability questionnaires like the Oswestry index, walking tolerance, strength testing, and whether leg symptoms are retreating toward the back.
A Different Way To Read The Report
MRI words describe shape, not destiny. The new European Spine Journal study does not settle the surgery question for everyone, but it does add evidence that a frightening image and a surgical case are not always the same thing. For someone in Hamlin or Horizon West reading that report in a parked car, the most useful next step may simply be an unhurried conversation with a clinician who reads the person as closely as the picture.
ABOUT: Dr. Jeffrey N. Shebovsky, DC | ReliefNow® Disc Joint & Nerve Center Hamlin | 5736 Hamlin Groves Trail, Suite 154, Winter Garden, FL 34787 | 407-706-4944 |
Disclaimer: This article is for informational and educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Consult a qualified healthcare provider before beginning any treatment program.
