Disc herniation refers to displacement of intervertebral disc material beyond the normal

confines of the disc, but involving less than 25% of the circumference (to distinguish it from
a disc bulge. A herniation may contain nucleus pulposus, vertebral endplate cartilage,
apophyseal bone/osteophyte and annulus fibrosus.

Disc herniations can be divided into groups in a variety of ways. Commonly they are divided
into protrusion vs extrusion:

protrusion
o base wider than herniation
o confined to disc level
o outer annular fibres intact
extrusion
o base (aka neck) narrower than herniation 'dome'
o may extend above or bellow endplates or adjacent vertebrae
o complete annular tear with passage of nuclear material beyond disc annulus
o disc material can then migrate away from annulus or become sequestered
Herniations can further be classified as:

contained
o with intact outer fibers of annulus fibrosus and posterior longitudinal ligament, or
o with intact posterior longitudinal ligament alone
not contained
o tear of outer fibers of annulus fibrosus and posterior longitudinal ligament

See also
lumbar disc disease
intervertebral disc disease nomenclature

Related articles
Spine
spinal anatomy
congential abnormalities of the spine[+]
spinal infection / inflammation / degeneration
 o osseous[+]
o intervertebral disc
intervertebral disc disease nomenclature
disc desiccation
annular fissure
disc bulge
disc herniation
disc protrusion
foraminal disc protrusion
disc extrusion
foraminal disc extrusion
intradural disc herniation
disc sequesteration
dorsal epidural disc migration
Schmorl node
discal cyst
high intensity zone
lumbar disc disease
acute calcific discitis
o epidural[+]
o intrathecal-extramedullary
o intramedullary[+]
spinal ischaemia[+]
spinal trauma
spinal tumours and cysts[+]
spinal vascular malformations[+]

Intervertebral disc
Dr Ayush Goel and A.Prof Frank Gaillard et al.

Intervertebral discs are located between the vertebral bodies of C2/3 to

L5/S1, totalling 23 in the conventional spine. Together they account for
approximately 25% of the total height of the vertebral column. This decreases
with age as disc height is lost.

The upper thoracic discs are the thinnest and in general thoracic discs are the
same width anteriorly as they are posteriorly. This is not the case in the
cervical and lumbar spine, where greater thickness anteriorly contributes to
the normal cervical and lumbar lordosis.

Each intervertebral disc is comprised of:

peripheral annulus fibrosus

central nucleus pulposus
hyaline cartilage (vertebral side) and fibrocartilage (nucleus pulposus side)
Above and below the intervertebral disc are the vertebral body endplates. The
inner layers of the annulus fibrosus and nucleus pulposus have neither
innervation nor blood supply; they receive nutrition via diffusion across the
vertebral body endplates. The outer fibres of the annulus fibrosus are
innervated by sinuvertebral nerves arising from the dorsal root ganglia.

Related pathology
lumbar disc disease
o intervertebral disc disease nomenclature
o loss of intervertebral disc space

Related articles
Spinal anatomy
osteology[+]
intervertebral disc
o annulus fibrosus
o nucleus pulposus
articulations[+]
ligaments[+]
musculature of the vertebral column[+]
spinal cord[+]
vascular supply[+]
References

Nucleus pulposus
Dr Henry Knipe and A.Prof Frank Gaillard et al.

The nucleus pulposus is the central part of each intervertebral disc.

Gross anatomy
It is located within the annulus fibrosus and between the vertebral body
endplates. It is composed of a thin lattice of collagen fibres (type II) which
traverse though hydrophilic glycosaminoglycans.

With ageing and degeneration the glycosaminoglycans are replaced with

fibrocartilage and the collagen type II replaced with type I (same as the
annulus fibrosus).

Disc desiccation is not responsible for disc height loss, as the nucleus
polposus volume remains the same with aging, but rather due to annular
bulging and end plate bowing.

Blood supply
nil: receives nutrition via diffusion across the vertebral body endplates

Nerve supply
none

Radiological appearance
MRI
high content of water which gives a normal disc its characteristic high T2
signalon MRI
loss of high T2 signal is due to disc desiccation

Related pathology
lumbar disc disease
o intervertebral disc disease nomenclature
Related articles
Spinal anatomy
osteology[+]
intervertebral disc
o annulus fibrosus
o nucleus pulposus
articulations[+]
ligaments[+]
musculature of the v

Osteoporotic spinal compression fracture

Dr Usman Bashir et al.

Osteoporotic spinal compression fractures occur as a result of

injury, commonly fall onto the buttock or pressure from normal activities, to the
weakened vertebrae due toosteoporosis.

Epidemiology
They have a reported incidence of 1.2 per 1000 person-years after 85 years of
age in the United States. However, they are largely unreported and are
probably more common radiographically (present up to 14% of women older
than 60 years in one study ).
1

Clinical presentation
Vertebral fractures present with pain and loss of mobility.

Radiographic features
Vertebral fractures require treatment when they are symptomatic, i.e. with pain
and loss of mobility. This defines the role of the radiologist in making an
accurate diagnosis.

Vertebral fracture should be diagnosed when there is loss of height in the

anterior, middle, or posterior dimension of the vertebral body that exceeds
20%. When in doubt, it is recommended that additional views or studies be
advised for confirmation.

Osteoporotic spine fractures can be graded based on vertebral height loss as:
 mild: 20-25%
moderate: 25-40%
severe: >40%

Acute vs chronic
Chronicity of the fracture indicates its temporal relationship with symptoms
and hence is an important determination.

On conventional imaging, acute fracture signs include cortical breaking or

impaction of trabeculae; in the absence of these signs fractures are chronic.

In uncertain cases, MRI signs of oedema (acute) and presence of radiotracer

uptake on bone scintigraphy (acute) help decide the age of the fracture.

Treatment and prognosis

Management options include:

non surgical
o observation/bracing
o medications: bisphosphonates for osteoporosis
surgical
o vertebroplasty