Mechanism of spontaneous resorption in lumbar disc herniation and new strategies for precision treatment

• A 2-year follow-up of a severe L5/S1 disc herniation demonstrated that comprehensive non-surgical treatment effectively promotes spontaneous resorption, with significant pain relief and MRI-confirmed reduction of the herniation. • Spontaneous resorption is driven by a coordinated interplay of inflammation, neovascularization, macrophage polarization, and matrix degradation, along with disruption of immune privilege and apoptosis/autophagy. • Key clinical predictors of resorption potential include herniation size and type, MRI rim enhancement, posterior longitudinal ligament integrity, Modic changes, and symptom duration/severity. • Future precision strategies should leverage single-cell sequencing, multimodal imaging, and deep learning to unravel molecular mechanisms, enable early prediction, and guide individualized treatment.