Disc Herniation Flashcards
What are the 2 sections of the intervertebral discs?
Outer ring - Anulus fibrosus
Inner ring - Nucleus pulposus
What is the role of the nucleus pulposus?
The gelatinous nucleus pulposus of the intervertebral discs - acts as a shock absorbers for impact in the spine and increases flexibility
What is the role of the anulus fibrosus?
To hold the nucleus pulposus within the intervertebral disc
What happens during a disc herniation?
The nucleus pulposus breaks through the anulus fibrosus and can press on the spinal cord or nerves
What are some of the causes of disc herniation?
Excessive force in younger people
Dehydration, elastin loss and collagen gain in older people
What is stage one of disc herniation?
Degenerative Discs
Anulus fibrosus is damaged and becomes torn/ torn repeatedly due to injuries.
This weekends the annulus fibrosus and leads to the nucleus pulposus being unable to retain fluid.
This decreases the thickness of the disc
What is stage 2 of disc herniation?
Prolapse
The nucleus pulposus begins to bulge into the annulus fibrosus due to it being weakened from injury.
This can cause slight impingement into the spinal canal.
This stage is also called bulging or protruding disc
What is stage 3 of disc herniation?
Extrusion
The gel like nucleus polposus breaks through the annulus fibrosus but remains with the disc
What is stage 4 of disc herniation?
Sequestration or sequestered disc
The nucleus pulposus breaks through the annulus fibrosus and can move outside the intervertebral disc into the spinal canal
Which direction will the disc herniate?
The disc will herniate in the direction it receives the least support from surrounding ligaments.
Posterolaterally - no support from either the anterior or posterior longitudinal ligament and the annulus fibrosus is relatively thin
What are the symptoms of disc herniation?
- localised acute pain where the disc herniated.
This pain is due to the - pressure of the ligaments and annulus fibrosus on spinal nerves.
- As well as localised inflammation caused by chemical irritation from the ruptured nucleus pulposus
Referred pain - perceived as coming from the dermatome relating to theat spinal root
Weakness in the myotome - pain due to a compressed spinal root is called radiculopathy
How are the nerves in the C-spine affected by herniated disc?
In the C-spine The root exits horizontally from the spinal cord.
So a foraminal and a paracentral hernial will affect the same nerve root
How will the Lumbar spine nerves be affected by a herniated disc?
In the Lumbar spine the nerve root exits the cord more vertically as the spinal cord is shorter than the spine.
Ao a formalinal hernia will affect the nerve root that exits at that level.
A paracentral hernia will affect nerve root below
What is ageing intervertebral discs (AKA Degenerating disc disease DDD) ?
The nuclei pulposus dehydrate and lose elastin and proteoglycans while gaining collagen.
The distinction between nucleus pulposus and annulus fibrosus is diminished and the nuclei pulposus can disappear.
Vertebral disc can increase as we age .
Can affect one or 2 veterbra and can affect any age
