PRESENTED BY

GERMAINE OCA, PTRP

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„ The annulus fibrosus
consist of collagen fibers.

„ The collagen fibers are

arranged in between 10 to
20 sheets called lamellae.

„ These are arranged in

concentric rings that
surround the nucleus
pulposus.

„ They are thick in anterior

and lateral portion of the
annulus but posteriorly they
are finer and more tightly
packed.

„ The collagen fibers lie

parellel to each other.
„ Each vertebral end plate
is a layer of cartiladge
about 0.6-1 mm thick.

„ Covers the area on the

vertebral area encircled by
the ring apophysis.

„ Nucleus pulposus is
entirely covered but
annulus fibrosus is only
66% covered by the end
plates.
„ The term prolapsed disc means the protrusion or
extrusion of the nucleus pulposus through a rent in
the annulus fibrosus.

„ It has a four stages

Bulging

Protrusion

Extrusion

sequestration
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„ It only occurs if the disc has deteriorated as
a result of repeated microtraumas and if the
annulus fibres have started to degenerate

„ Disc prolapse usually follows lifting of

weight with the trunk flexed forward.

„ Disc prolapse occurs in three stages

„ ›irst stage
Trunk flexion flattens the
disc anteriorly and open out
the intervertebral space
posteriorly

„ Second stage
As soon as the weight is
lifted the increased axial
compression force crushes
the whole disc and violently
drives the nuclear substance
posteriorly until it reaches
the deep surface of PLL.
„ Third stage

With the trunk nearly

straight , the path
taken by the herniating
mass is the closed by
the pressure of
vertebral plateaus and
the hernia remains
trapped under the
posterior longitudinal
ligament.
Prolapse occurs in two manners also

4 Sudden disc prolapse

4 Gradual disc prolapse
„ Degenerative changes occur disc before
displacement of the nuclear material.
„ These changes are :-
@ Softening of the nucleus and its
fragmentation
@ Weakening and the disintegration of the
posterior part of the annulus
„ The nucleus is under positive
pressure at all times

„ When the annulus becomes weak,

either because a small area of entire
thickness has disintegrated
spontaneously or because of injury,
The nucleus tends to bulge out.
„ This is the stage of repair.
„ This begins alongside of degeneration.
the residual nucleus pulposus become
fibrosed.
„ The extruded nucleus pulposus
becomes flattened,fibrosed and finally
undergoes calcification.
Three types of annulus tears

„ Concentric(circumferential)
tears
„ Tears between adjacent lamellae

„ Rim lesions
„ ›ocal circumferential avulsion of
peripheral annulus

„ Radial fissure
„ Allows nucleus material to
escape
„ Bulging
At this early stage, the disc is
stretched and doesn·t
completely return to its normal
shape when pressure is
relieved. It retains a slight
bulge at one side of the disc.

Some of the inner disc fibres

could be torn and the soft jelly
(a
   ) is spiling
outwards into the disc fibres
but not out of the disc
„ Protrusion
At this stage, the
bulge is very
prominent and the
soft jelly centre has
spilled out to the
inner edge of the
outer fibres, barely
held in by the
remaining disc
fibres.
„ Extrusion

In the case of a
herniated spinal disc,
the soft jelly has
completely spilled
out of the disc and
now protruding out
of the disc fibres.
„ Sequestration

Here some of the

jelly material is
breaking off away
from the disc into
the surrounding
area
„ CLINICAL ANATOMY O› LUMBAR SPINE ² BOGDUK

„ KINESIOLOGY O› THE JOINTS ² KAPANDJI

„ CLINICAL ORTHOPAEDIC REHAB ² BROTZMAN

„ ESSENTIAL ORTHOPAEDICS - MAHESWARI