LINKS:
Doug's Current Treatment Diary:
Basic Anatomy of the Lumbar Disc:
Disc Herniation - How it evolves:
Disc Herniation continued: Pain!
RESEARCH:
Disc Herniation & Radiculopathy Facts:
Pathophysiology of Degenerative Disc Disease:
IMAGES:
MRI - Cervical Anatomy & axial post ACDF:
Disc Herniation: How it evolves cont.
Now things get Painful!!!
There is
one more type of IDD that is described in some of the literature. This tearing
phenomenon look like a 'ships
anchor' on Discogram. (click
'ships anchor' to see a real picture) This occurs because the very
outer layer of the disc is slightly tougher than the inner layers.
Because of its extra toughness the escaping nuclear material will start to
spread outward around the disc - circumferentially. This is called by some
a 'Grade 4 IDD (aka: anular tear) and is a very, very painful condition.
The next step in the evolution
of lumbar disc disease would be the bulging of the outer layer of the disc.
Again that tougher outer layer is desperately trying to avoid rupturing.
The weakening inner tearing has widened and more nuclear material is pushing on
the outer layer of the anulus. This pushing is causing the outer layer to
'Bulge' outward. Now These 'disc bulges' are often seen on MRI and 'ignored' by the physician
as they had been lead to believe that these are normal. Jensen & Borden
both demonstrated that a percentage of non-symptomatic patients do show up Disc
Bulges on MRI. These bulges can be extremely painful. Unfortunately
the MRI can not show us what's going on inside the disc.
A Discogram will need to be performed to show if the disc
is really the pain generator.
Finally the last outer layer of
the disc breaches and the nuclear material is free to 'seep' onto the sensitive
spinal nerves.... The patient now may start to feel pain, burning, numbness,
down the lateral part of the thigh. This is often termed a 'Sub-ligamentous'
Disc Herniation (aka:Protrusion).
In
this next picture the disc herniation has worsened. Now, not only is the
nerve root getting 'chemically' irritated, its also being physically irritated
by 'compression' from the extruded disc material. These herniations
typically are over 5mm in size. Our Clinic record is an 18mm HNP.
(This patient actually did very well with our conservative care an avoided
surgery.)