- 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
1 2 3 4 5
The Intervertebral Disc
Free Disc Fragment (Sequestered Disc)
The term free disc fragment refers to the separation or migration of piece of nuclear disc material from its originating or parent disc. The free fragment is no longer connected to its origin. This is often referred to as a sequestered disc herniation. Occasionally, a free disc fragment or free floating piece of disc material will migrate behind the body of the adjacent vertebrae making it difficult to determine which disc it may have originated from. A disc fragment may remain under the spinal ligament or may migrate to a transligamentous position within the epidural space. Disc fragments may migrate upward or downward from the parent disc. The risk for developing a cauda equina syndrome is increased with intradural migration of an extruded disc fragment in the low back. MRI is the best imaging method to confirm the presence of a free (sequestered) disc fragment.
Disc Herniation and Extrusion:
The term disc herniation refers to the migration of the spongy like center of a disc through fibers of the outer ring or annular fibers of the disc. The term disc extrusion means that the herniated fragment of the spongy-like center of the nucleus has migrated all the way through the ring of surrounding annular fibers and has moved outside the outer boundary of the intervertebral disc. If the piece of extruded disc material breaks off and is separated from the parent, it is referred to as disc sequestration. This may also be referred to as a disc extrusion with sequestration. Disc extrusion might contribute to nerve compromise in two ways. With disc extrusion, there is generally a greater concentration of chemicals outside the disc that contribute to inflammation of adjacent tissues including the nerves. This combined with compression of the adjacent tissues further leads to risk for the development of signs and symptoms.
A vast majority of disc herniations and disc extrusions that produce symptoms compromise a single adjacent nerve. This most commonly occurs at the L4-L5 level and the L5-S1.
Bone Spurs:
Aside from abnormalities of the intervertebral disc the most common type of structural abnormality in the spine, which may compress a spinal nerve or spinal cord, is the bone spur. Bone spurs are also referred to as osteophytes. The term osteophyte refers to extra growth of bone which projects away from the normal bony boundaries. A bone spur may project into regions where there are pain sensitive or vital neurological structures. Osteophytes tend to develop over a long a period of time. They do not show up immediately after an acute trauma or injury or like a disc herniation might. Once a bone spur or osteophyte develops it will not go away on its own.
Each of these bones has a special lining referred to as the periosteum. This special lining helps to provide nutrients to the bone and helped also to protect the bone. The periosteum is pain sensitive. If the periosteum is physically disrupted or becomes chronically inflamed, it may facilitate bone growth underneath it. Some osteophytes will develop due to abnormal physical loads placed upon the bone. The surfaces of all bones are exposed to physical stress. Abnormal stress placed upon the supporting ligaments and cartilage can cause development of extra bone growth leading to osteophyte development. Osteophytes can project into the central spinal canal or the lateral openings referred to the neuroforamen. Narrowing of the central canal is referred to as a central spinal stenosis and narrowing of the lateral canal or the neuroforamen is referred to as lateral spinal stenosis. It is not uncommon at the level of excessive osteophyte development for there to be both central and lateral stenosis present.
The term free disc fragment refers to the separation or migration of piece of nuclear disc material from its originating or parent disc. The free fragment is no longer connected to its origin. This is often referred to as a sequestered disc herniation. Occasionally, a free disc fragment or free floating piece of disc material will migrate behind the body of the adjacent vertebrae making it difficult to determine which disc it may have originated from. A disc fragment may remain under the spinal ligament or may migrate to a transligamentous position within the epidural space. Disc fragments may migrate upward or downward from the parent disc. The risk for developing a cauda equina syndrome is increased with intradural migration of an extruded disc fragment in the low back. MRI is the best imaging method to confirm the presence of a free (sequestered) disc fragment.
Disc Herniation and Extrusion:
The term disc herniation refers to the migration of the spongy like center of a disc through fibers of the outer ring or annular fibers of the disc. The term disc extrusion means that the herniated fragment of the spongy-like center of the nucleus has migrated all the way through the ring of surrounding annular fibers and has moved outside the outer boundary of the intervertebral disc. If the piece of extruded disc material breaks off and is separated from the parent, it is referred to as disc sequestration. This may also be referred to as a disc extrusion with sequestration. Disc extrusion might contribute to nerve compromise in two ways. With disc extrusion, there is generally a greater concentration of chemicals outside the disc that contribute to inflammation of adjacent tissues including the nerves. This combined with compression of the adjacent tissues further leads to risk for the development of signs and symptoms.
A vast majority of disc herniations and disc extrusions that produce symptoms compromise a single adjacent nerve. This most commonly occurs at the L4-L5 level and the L5-S1.
Bone Spurs:
Aside from abnormalities of the intervertebral disc the most common type of structural abnormality in the spine, which may compress a spinal nerve or spinal cord, is the bone spur. Bone spurs are also referred to as osteophytes. The term osteophyte refers to extra growth of bone which projects away from the normal bony boundaries. A bone spur may project into regions where there are pain sensitive or vital neurological structures. Osteophytes tend to develop over a long a period of time. They do not show up immediately after an acute trauma or injury or like a disc herniation might. Once a bone spur or osteophyte develops it will not go away on its own.
Each of these bones has a special lining referred to as the periosteum. This special lining helps to provide nutrients to the bone and helped also to protect the bone. The periosteum is pain sensitive. If the periosteum is physically disrupted or becomes chronically inflamed, it may facilitate bone growth underneath it. Some osteophytes will develop due to abnormal physical loads placed upon the bone. The surfaces of all bones are exposed to physical stress. Abnormal stress placed upon the supporting ligaments and cartilage can cause development of extra bone growth leading to osteophyte development. Osteophytes can project into the central spinal canal or the lateral openings referred to the neuroforamen. Narrowing of the central canal is referred to as a central spinal stenosis and narrowing of the lateral canal or the neuroforamen is referred to as lateral spinal stenosis. It is not uncommon at the level of excessive osteophyte development for there to be both central and lateral stenosis present.
1 2 3 4 5
