Disc injury

Question 1

Basic Structure of a disc

Answer 1

• Annulus fibrosis
• Nucleus pulposus
• Vertebral end plates superiorly and inferiorly

Question 2

Grade I,II,III Internal Disc disruption definition

Answer 2

when the radial fissures extend through the radius of the disc from the nucleus outwards and reach the inner middle then the outer 1/3 of the annulus

Question 3

Contained disc herniation definition

Answer 3

• Stretching of the innervated outer 1/3 of the annulus and stretching of the innervated posterior longitudinal ligament
• Likely to cause somatic and somatic referred pain – likely to be vague and non-dermatomal distribution in the lower limb

Question 4

Uncontained disc herniation definition

Answer 4

• Nuclear material has penetrated the outer annulus and posterior longitudinal ligament.
• Sitting against the adjacent exiting spinal nerve root
• Somatic pain from damaged outer annulus
• Inflammatory chemicals from disc inflammation which irritate the exiting nerve root

Question 5

management of radicular pain

Answer 5

 Influence the disc herniation (McKenzie approach)?
 Try to reduce nerve oedema and compression by affecting the size of the IVF with manual therapy
 Modulate pain
◦ Exercises
◦ Electrotherapy
◦ Medication

Question 6

Mechanism of Radicular Pain

Answer 6

 Simple Compression of normal nerve root does not cause pain. Sustained pain occurs only when the nerve root has been previously injured or inflamed
 Compression of the DRG does produce a massive + sustained discharge of afferent activity (pain)
 Mechanism of Radicular Pain is likely to be due to intraneural and perineural inflammation + also ischaemia of nerve roots, which may result from compression
 Radicular pain can be partially or completely resolve in 60% of patients within 12 weeks. If pain remains, patients offered MRI and/or possible surgery