Author: George Wang
Lower back pain is common among population. Prior to treatment by health care professionals, it is useful to have an understanding on different diagnostic categories of lumbar discs terminology.
Defines discs that are morphologically normal, without the consideration of the clinical context and not inclusive of degenerative, developmental, or adaptive changes that could be considered clinically normal (Fardon, Williams, Dohring, Murtagh, Rothman & Sze, 2014, p.3).
Includes discs that are congenitally abnormal or that have undergone changes in their morphology as an adaptation of abnormal growth of the spine, such as from scoliosis or spondylolisthesis (Fardon, Williams, Dohring, Murtagh, Rothman & Sze, 2014, p.3).
Includes subcategories of annular fissure, degeneration, and herniation
Annular fissure refers to separations between the annular fibers or separation of annular fibers from their attachments to the vertebral bone (Fardon, Williams, Dohring, Murtagh, Rothman & Sze, 2014, p.3).
Degeneration refers to all of the following: desiccation, fibrosis, narrowing of the disc space, diffuse bulging of the annulus beyond the dis space, fissuring, mucinous degeneration of the annulus, intradiscal gas, osteophytes of the vertebrae apophyses, defects, inflammatory changes, and sclerosis of the end plates (Fardon, Williams, Dohring, Murtagh, Rothman & Sze, 2014, p.4)
Herniation refers to a localized r focal displacement f disc material beyond the limits of the intervertebral disc space. The disc material may be nucleus, cartilage, fragmented apophyseal bone, annular tissue, or any combination thereof (Fardon, Williams, Dohring, Murtagh, Rothman & Sze, 2014, p.4).
Herniated disc may be classified as protrusion or extrusion, contained or uncontained (Fardon, Williams, Dohring, Murtagh, Rothman & Sze, 2014, p.5-6).
- Protrusion is present if the greatest distance between the edges of the dis material presenting outside the disc space is less than the distance between the edges of the base of that disc material extending outside the disc space
- Extrusion is present when, in at least one plane, any one distance between the edges of disc material beyond the disc space is greater than the distance between the edges of the base of the disc materials beyond the disc space or when no continuity exists beyond the disc space and that within the disc space
- Contained refers to if the displaced portion is covered by outer annulus fibers and/or the posterior longitudinal ligament;
- Uncontained when absent of such covering
Includes disruption of the disc associated with physical and/or imaging evidence of violent fracture and/or dislocation and does not include repetitive injury, contribution of less than violent trauma to the degenerative process, fragmentation of the ring apophysis in conjunction with disc herniation, or disc abnormalities in association with degenerative subluxations (Fardon, Williams, Dohring, Murtagh, Rothman & Sze, 2014, p.6-7).
Includes infections, infection-like inflammatory discitis, and inflammatory response to spondyloarthropathy. Includes inflammatory spondylitis of subchondral end plate and bone marrow manifested by Modic Type I MRI changes and usually associated with degenerative pathological changes in the discs (Fardon, Williams, Dohring, Murtagh, Rothman & Sze, 2014, p.7).
Refer to primary or metastatic morphologic changes of disc tissues caused by malignancy (Fardon, Williams, Dohring, Murtagh, Rothman & Sze, 2014, p.7).
Miscellaneous paradiscal masses of uncertain origin
Refer to a paradiscal mass or an increase in the size of herniated disc material may be created by epidural bleeding and/or edema, unrelated to trauma or other known origin (Fardon, Williams, Dohring, Murtagh, Rothman & Sze, 2014, p.7).
Fardon, D. F., Williams, A. L., Dohring, E. J., Murtagh, F. R., Gabriel Rotheman, S. L., & Sze, G. K. (n.d.). Lumbar disc nomenclature: Version 2.0 Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. The Spine Journal. doi:https://doi.org/10.1016/j.spinee.2014.04.022
Link to the article: https://ruperthealth.com/research/lumbardisc.pdf