- Anatomy of The Spine
- Back Pain in Children
- Caring for your Spine
- Emerging Spinecare Trends
- Evaluation of Spinal Disorders
- Exercise and The Spine
- Intervention - Spinal Disorders
- Intervertebral Disc
- Non Surgical Options
- Nutrition and Spinecare
- Options for Spine Treatments
- Pregnancy and Back Pain
- Prevalence of Spine Disorders
- Sleep and the Spine
- Spinecare Introduction
- Spinehealth and Disease
- Surgical Interventions
- Treatment with Medications
- Understanding Back Pain
Spinecare Topics
Intervertebral Disc
The Intervertebral Disc
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The Intervertebral Disc
An additional element of a diagnostic discogram uses imaging to evaluate the migration pattern of a dye or other imaging agent within the intervertebral disc. This form of discogram can be performed with the aid of imaging technology such as fluoroscopy, magnetic resonance imaging (MRI) and/or computerized tomography (CT). The studies performed with X-rays or fluoroscopy requires the administration (injection) of an iodine-based contrast agent into the disc to reveal the presence of and internal relationship of “disc tears,� which may be present.
Classification of Disc Problems
The terminology used to classify disc problems is often confusing as well as imprecise. Disc problems can be generally classified into four primary categories based upon their appearance on advance imaging such as CT or MRI. The classifications are annular bulge; disc protrusion (herniation); disc extrusion; and disc fragment (sequestration). Disc problems should also be classified according to the anatomical (structural) location. The size of a disc herniation can be characterized as a small, moderate or large. The location of a disc herniation should be described in relationship to midline spinal anatomy. The location of the disc herniation should be described as central, paracentral or lateral.
Annular Bulging (Disc Bulge)
The term annular bulge should be reserved for describing symmetric annular extension beyond the posterior margins of the vertebral body without evidence of internal annular fiber disruption (“disc tears�) or a disc bulge may not directly contact the adjacent spinal nerve root. A disc bulge may be accompanied by degenerative changes. One of the most important criteria for identifying a disc bulge is that it is broad based and relatively symmetric. Short-based focal disc bulges are more likely to be associated with a disc herniation.
Disc Protrusion (Herniation)
A disc herniation represents rupture of gel-like nuclear material through a defect in the supportive disc fibers (annulus) producing a focal extension of the outer portion of the disc beyond the adjacent vertebral body margin. The term disc protrusion is synonymous with the term subannular contained nuclear herniation. Portion of the nuclear material may migrate through compromised internal disc (annular) fibers without extruding beyond the outer annular fibers. This produces a focal asymmetric extension of disc material beyond the vertebral margin without the gradual tapering typically observed with an annular bulge.
Disc Extrusion
The classification of an extruded disc is applied when portions of the nucleus pulposus and endplate cartilage have migrated outside the boundaries of the outer disc (annular) fibers. Disc extrusions like herniations can be qualified by their size and location. This type of herniation may lie under the spinal ligament (subligamentous) or may pierce through the spinal ligament (transligamentous). MRI studies reveal that a moderate sized or large subligamentous disc extrusion will significantly lift up or tent the posterior longitudinal ligament (PLL). The extruded nuclear material will take the path of least resistance and will subsequently migrate upward and/or downward under the spinal ligament. A disc extrusion may release inflammatory chemicals into the nerve root area that may lead to signs and symptoms of nerve irritation or compromise. Chronic stretching of the spinal ligament (PLL) may contribute to chronic low back pain. The PLL contains an extensive network of free pain endings.
Classification of Disc Problems
The terminology used to classify disc problems is often confusing as well as imprecise. Disc problems can be generally classified into four primary categories based upon their appearance on advance imaging such as CT or MRI. The classifications are annular bulge; disc protrusion (herniation); disc extrusion; and disc fragment (sequestration). Disc problems should also be classified according to the anatomical (structural) location. The size of a disc herniation can be characterized as a small, moderate or large. The location of a disc herniation should be described in relationship to midline spinal anatomy. The location of the disc herniation should be described as central, paracentral or lateral.
Annular Bulging (Disc Bulge)
The term annular bulge should be reserved for describing symmetric annular extension beyond the posterior margins of the vertebral body without evidence of internal annular fiber disruption (“disc tears�) or a disc bulge may not directly contact the adjacent spinal nerve root. A disc bulge may be accompanied by degenerative changes. One of the most important criteria for identifying a disc bulge is that it is broad based and relatively symmetric. Short-based focal disc bulges are more likely to be associated with a disc herniation.
Disc Protrusion (Herniation)
A disc herniation represents rupture of gel-like nuclear material through a defect in the supportive disc fibers (annulus) producing a focal extension of the outer portion of the disc beyond the adjacent vertebral body margin. The term disc protrusion is synonymous with the term subannular contained nuclear herniation. Portion of the nuclear material may migrate through compromised internal disc (annular) fibers without extruding beyond the outer annular fibers. This produces a focal asymmetric extension of disc material beyond the vertebral margin without the gradual tapering typically observed with an annular bulge.
Disc Extrusion
The classification of an extruded disc is applied when portions of the nucleus pulposus and endplate cartilage have migrated outside the boundaries of the outer disc (annular) fibers. Disc extrusions like herniations can be qualified by their size and location. This type of herniation may lie under the spinal ligament (subligamentous) or may pierce through the spinal ligament (transligamentous). MRI studies reveal that a moderate sized or large subligamentous disc extrusion will significantly lift up or tent the posterior longitudinal ligament (PLL). The extruded nuclear material will take the path of least resistance and will subsequently migrate upward and/or downward under the spinal ligament. A disc extrusion may release inflammatory chemicals into the nerve root area that may lead to signs and symptoms of nerve irritation or compromise. Chronic stretching of the spinal ligament (PLL) may contribute to chronic low back pain. The PLL contains an extensive network of free pain endings.
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