References: 2 internet http://www.mondofacto.com/facts/dictionary?herniated+nucleus+pulposus http://www.umm.edu/spinecenter/education/anatomy_and_function_of_the_spine.

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I. DEFINITION Herniated nucleus pulposus

A herniated intervertebral disk (nucleus pulposus) is one which has become displaced (prolapsed) from itsnormal position in between the vertebral bodies of the spine. Herniated disks often impinge on nearby nerve structures resulting in pain and neurologic symptoms. A clinical situationwhere the radicular nerve (nerve root) is compressed by the prolapsed disk is referred to as a radiculopathy. This problemtends to occur most commonly in the cervical and lumbar spine.

II. ETIOLOGY
Herniated discs can occur in children, although this is rare. Usually a true herniated nucleus pulposus is most common in young and middle-aged adults. In older folks, the degenerative changes that occur in the spine with aging actually make it less likely they will suffer a true herniated disc. Discs can rupture suddenly because of too much pressure all at once on a disc. For example, falling from a ladder and landing in a sitting position can cause a great amount of force across the spine. If the force is strong enough, either a vertebra can fracture or break, or a disc can rupture. Bending over places a great amount of force on the discs between each vertebra. If you bend and try to lift something that is too heavy, the force can cause a disc to rupture. Discs can also rupture from a small amount of force - usually due to weakening of the annulus fibers of the disc by repeated injuries that add up over time. As the annulus becomes weaker, at some point you lift something or bend in such a way that you cause too much pressure across the disc. The weakened disc ruptures while you are doing something that five years earlier would not have caused a problem. Such is the aging process of the spine. A herniated disc causes problems in two ways. First, the material that has ruptured into the spinal canal from the nucleus pulposus can cause pressure on the nerves in the spinal canal. There is also some evidence that the nucleus pulposus material causes a chemical irritation of the nerve roots. Both the pressure on the nerve root and the chemical irritation can lead to problems with how the nerve root functions. The combination of the two can cause pain, weakness, and/or numbness in the area of the body that the nerve usually goes. Herniated discs can occur in children, although this is rare. Usually a true herniated nucleus pulposus is most common in young and middle-aged adults. In older folks, the degenerative changes that occur in the spine with aging actually make it less likely they will suffer a true herniated disc.

Discs can rupture suddenly because of too much pressure all at once on a disc. For example, falling from a ladder and landing in a sitting position can cause a great amount of force across the spine. If the force is strong enough, either a vertebra can fracture or break, or a disc can rupture. Bending over places a great amount of force on the discs between each vertebra. If you bend and try to lift something that is too heavy, the force can cause a disc to rupture. Discs can also rupture from a small amount of force - usually due to weakening of the annulus fibers of the disc by repeated injuries that add up over time. As the annulus becomes weaker, at some point you lift something or bend in such a way that you cause too much pressure across the disc. The weakened disc ruptures while you are doing something that five years earlier would not have caused a problem. Such is the aging process of the spine. A herniated disc causes problems in two ways. First, the material that has ruptured into the spinal canal from the nucleus pulposus can cause pressure on the nerves in the spinal canal. There is also some evidence that the nucleus pulposus material causes a chemical irritation of the nerve roots. Both the pressure on the nerve root and the chemical irritation can lead to problems with how the nerve root functions. The combination of the two can cause pain, weakness, and/or numbness in the area of the body that the nerve usually goes.

Incident rate: an estimated 1.7 million occurred worldwide and to be exceed to 6 million by 2050. III.ANATOMY
What exactly is the spine? Your spine is made up of 24 small bones (vertebrae) that are stacked on top of each other to create the spinal column. Between each vertebra is a soft, gel-like cushion called a disc that helps absorb pressure and keeps the bones from rubbing against each other. Each vertebra is held to the others by groups of ligaments. Ligaments connect bones to bones; tendons connect muscles to bones. There are also tendons that fasten muscles to the vertebrae. The spinal column also has real joints (just like the knee or elbow or any other joints) called facet joints. The facet joints link the vertebrae together and give them the flexibility to move against each other.

Each vertebra has a hole in the center, so when they stack on top of each other they form a hollow tube that holds and protects the entire spinal cord and its nerve roots. The spinal cord itself is a large collection of nerve tissue that carries messages from your brain to the rest of your body. In order for your body to function, you need your nerves. The spine branches off into thirty-one pairs of nerve roots. These roots exit the spine on both sides through spaces (neural foramina) between each vertebra. The spine itself has three main segments: the cervical spine, the thoracic spine, and the lumbar spine. The cervical is the upper part of the spine, made up of seven vertebrae (bones). The thoracic is the center portion of the spine, consisting of 12 vertebrae. The lower portion of the spine is called the lumbar spine. It is usually made up of five vertebrae, however, some people may have six lumbar vertebrae. Having six vertebrae does not seem to cause a problem. Below the lumbar spine is the sacrum. The sacrum is actually a group of specialized vertebrae that connects the spine to the pelvis. During development (those nine months before birth), these vertebrae grow together or fuse creating one large "specialized" vertebral bone that forms the base of your spine and center of your pelvis. The nerves that leave the spine in the sacral region control the bowel and bladder functions and give sensation (feeling) to the crotch area. The normal spine has an "S"-like curve when looking at it from the side. This allows for an even distribution of weight. The "S" curve helps a healthy spine withstand all kinds of stress. The cervical spine curves slightly inward, the thoracic curves outward, and the lumbar curves inward. Even though the lower portion of your spine holds most of the body's weight, each segment relies upon the strength of the others to function properly. Intervertebral Disc The intervertebral discs are flat, round "cushions" that act as shock absorbers between each vertebra in your spine. There is one disc between each vertebra. Each disc has a strong outer ring of fibers called the annulus, and a soft, jelly-like center called the nucleus pulposus. The annulus is the disc's outer layer and the strongest area of the disc. It also helps keep the disc's center intact. The annulus is actually a strong ligament that connects each vertebra together. The mushy nucleus of the disc serves as the main shock absorber. The nucleus is made up of tissue that is very moist because it has high water content. The water content helps the disc act like a shock absorber - somewhat like a waterbed mattress.

IV. PATHOPHYSIOLOGY Rupture of the annulus pulposus allows part of the