Lumbar intervertebral disc herniation is a common cause of low back and radicular leg pain, traditionally managed with a combination of conservative therapies and, when indicated, surgical discectomy. An intriguing phenomenon observed in many patients is the spontaneous resorption of herniated disc material over time, often correlating with significant symptom improvement. This article is presented as a narrative review synthesizing experimental, imaging, and clinical literature relevant to spontaneous disc resorption and its implications for clinical decision-making. This paper provides a comprehensive overview of spontaneous disc herniation resorption, exploring the underlying pathophysiological mechanisms and the factors that predict which herniations are likely to regress without surgery. Key mechanisms include inflammatory-mediated degradation of disc fragments, neovascularization with macrophage infiltration and phagocytosis of extruded nucleus pulposus tissue, and biological processes such as enzymatic matrix breakdown and cellular apoptosis that collectively lead to shrinkage of the herniated mass. Patient and disc characteristics that favour spontaneous resorption are identified, such as younger age, extruded or sequestered fragment type, larger initial herniation size, and robust inflammatory response on imaging, whereas certain chronic degenerative changes may reduce this likelihood. We also review current clinical guidelines and expert recommendations on when surgical intervention is warranted versus when conservative management and observation are appropriate. Understanding the probability of natural disc fragment resolution is critical in guiding treatment decisions. In the absence of severe neurological deficits or intractable pain, a period of non-operative management can often be pursued safely, given that the majority of patients experience substantial relief within a few months as discs regress. Conversely, timely surgery is advised for those with neurological compromise or refractory symptoms. By synthesizing the latest evidence on spontaneous disc herniation resorption and its predictors, this review aims to assist neurosurgeons and spine specialists in optimizing patient selection for conservative care and identifying the proper timing for surgical intervention to achieve the best clinical outcomes. Given the narrative design, conclusions are based on synthesis of heterogeneous evidence rather than formal comparative analysis.

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment disorder, with a lifetime prevalence estimated at approximately 10%. This narrative review explores the historical evolution, current management strategies, and emerging trends in CTS diagnosis and treatment. Early recognition of CTS led to the development of conservative interventions, including splinting, corticosteroid injections, and physical therapy, aimed at alleviating median nerve compression and associated symptoms. The advent of open carpal tunnel release established surgery as the definitive treatment for moderate-to-severe CTS, with subsequent refinements—such as mini-open and endoscopic techniques—focused on minimizing tissue trauma and expediting recovery. Comparative studies demonstrate similar long-term efficacy between surgical modalities, though endoscopic approaches often provide faster short-term recovery. Advances in diagnostic imaging, including high-resolution ultrasound, have improved early detection and dynamic assessment of median nerve compression. Emerging therapies, such as regenerative biologics, neuromobilization, and minimally invasive surgical innovations, offer promising adjuncts to current care. Despite substantial progress, further research is needed to clarify optimal patient selection, refine minimally invasive techniques, and explore regenerative interventions. This review underscores the importance of individualized, evidence-based, and patient-centered approaches to CTS management, integrating both established and emerging strategies to optimize functional outcomes and quality of life.

Introduction. The treatment of patients with lumbar disc herniation can be conservative or surgical, depending on the patient’s characteristics, the disease, and treatment possibilities. This study aims to compare the intensity of pain, the presence of Lasègue’s sign, and the degree of neurological deficits in patients with lumbar disc herniation before and after the operation. Additionally, the degree of intervertebral disc degeneration, evaluated by magnetic resonance imaging findings on the outcome will be determined. Material and Methods. A retrospective study involved 50 patients aged 18 to 45 who underwent microdiscectomy procedure. Parameters including pain intensity on the visual-analog scale, Lasègue’s nerve stretching test, sensory deficits, motor deficits, and the degree of intervertebral disc degeneration according to the Pfirrmann grading system were assessed preoperatively and in the early postoperative period. Results. Intervertebral disc herniation most commonly occurred at the L4-5 and L5-S1 levels in our patients. Pain intensity significantly decreased from a preoperative score of 7.6 to 2.4 postoperatively. There was also a significant decrease in the number of patients with positive Lasègue’s sign. According to the Pfirrmann grading system, 38% of patients had mild degenerative changes in the intervertebral disc, while 62% had severe degenerative changes. Conclusion. Microdiscectomy is the gold standard in surgical treatment of lumbar disc herniation. In the early postoperative period, patients experience a significant reduction in pain intensity with subsequent improvement of sensory and motor deficits. Surgical treatment of lumbar disc herniation, when indicated appropriately, carries a high success rate.

Background/Aim. In an era of rapid technological innovation and growing patient expectations, healthcare systems worldwide face the need for continuous improvement in service quality. The Service Quality model (SERVQUAL) is a validated instrument for measuring service quality, based on comparing patients? expectations with their perceptions of the service provided. The difference (gap) between these two measures is assessed using a five-point Likert scale across five dimensions: tangibility, reliability, responsiveness, assurance, and empathy. The aim of this study was to measure and compare expectations and perceptions of patients undergoing neurosurgical services, and to examine whether the size of the gap differs between SERVQUAL dimensions. Methods. The study included a total of 60 patients who underwent surgery for degenerative lumbar and cervical spine diseases at the Clinic for Neurosurgery, University Clinical Center of Vojvodina, Novi Sad, Serbia, between June and September 2024. A modified SERVQUAL questionnaire was used for data collection. Data were collected on admission and before the patients? discharge. Data were analyzed using descriptive statistics, paired t-tests to compare expectations and perceptions, and analysis of variance to examine differences across sociodemographic groups. Results. Patients had positive perceptions of the provided services. The results indicated the existence of a gap between patients? expectations and their perceptions of the services received. Mean expectations were high across dimensions (overall 4.85; range 4.79?4.88), as were perceptions (overall 4.90; range 4.85?4.94). All gaps were positive (perceptions > expectations). Dimension-specific gaps were as follows: tangibility 0.06 (p = 0.196), reliability 0.05 (p = 0.132), responsiveness 0.04 (p = 0.249), assurance 0.06 (p = 0.107), empathy 0.06 (p = 0.039). Only the empathy dimension reached statistical significance. No significant differences emerged across sociodemographic subgroups. Conclusion. The SERVQUAL method provided clear insights into patients? perceptions of the quality of neurosurgical services. The findings from this study can contribute to improving service quality and increasing patient satisfaction, positively influencing clinical outcomes and the healthcare system as a whole.

Introduction. The literature describes several ways to approach the thoracic spinal segment, but there are still many dilemmas regarding what is best to do after a complete discectomy, regardless of the surgical approach chosen. The incidence of postoperative kyphosis is higher if a posterior surgical approach to the spine is performed, and there are no clearly defined indications for the application of intervertebral fusion (IF) after an anterior approach. The aim of the paper was to highlight the low morbidity of the transthoracic multi-disciplinary approach, as well as a potential solution for a good, natural IF of the adjacent vertebrae without expanding and prolonging the duration of the surgical procedure itself. Case report. A 44-year-old woman presented with severe anterior compressive myelopathy caused by a calcified thoracic disc herniation in the space between the T10-11 vertebrae. A minimally invasive, open, transthoracic approach was per-formed with decompression of the spinal canal at the specified level and IF was achieved with an autologous rib graft during the same procedure. A control examination of the thoracolumbar segment using the magnetic resonance imaging showed that there is no more compression of the spinal cord and also showed a good IF without an increase in the level of kyphosis. Conclusion. Significant thoracic disc herniation is a rare and challenging surgical lesion. The anterior mini-open transthoracic approach provides good exposure to the relevant structures and is considered minimally invasive. The benefits of subsequent IF after the transthoracic surgical approach should always be taken into account for each individual patient, thus minimalizing the postoperative morbidity.