Slipped disc
The intervertebral discs[1]Raj, P. Prithvi. Intervertebral disc. Anatomy‐physiology‐pathophysiology‐treatment. Pain Practice 8.1 2008 18-44.I'm structures formed by a central nucleus (nucleus pulposus) surrounded by a fibrous ring. They have a thickness of approx 7-10 mm and a diameter of 4 cm. The nucleus pulposus it is made up of a gelatinous substance containing collagen fibers, elastin and aggrecan (protein capable of binding large amounts of water) highly hydrated. The nucleus pulposus, under physiological conditions, is composed of 88% water. L‘fibrous ring is formed from 15-25 concentric rings of fibro-cartilage and has the purpose of containing the central nucleus pulposus and conferring resistance to the entire structure.
The intervertebral discs are located between the vertebral bodies with which they form the main joints of the spine and occupy a third of its height. Between the first two cervical vertebrae (atlante ed epistropheo) and between the vertebrae of the sacrum and coccyx are not present. The intervertebral discs constantly transmit the loads deriving from body weight and muscle activity through the vertebral column and in doing so they function as actual biological shock absorbers. They also confer flexibility to the spine allowing flexion-extension and lateral inclination movements but also rotation.
Disc herniation consists of protrusion of the gelatinous material of the disc (nucleus pulposus) through the annulus fibrosus. In many cases, a gradual reabsorption of the expelled material takes place, especially in the case of the most voluminous discs. The 50% of patients with proven symptomatic disc herniation experience remission of symptoms within 1-6 months without the need for surgery, [2]Brotzman, S. Brent, and Robert C. Manx. Clinical orthopaedic rehabilitation e-book. An evidence-based approach-expert consult. Elsevier Health Sciences, 2011..
CLASSIFICATION IN RELATION TO THE DEGREE OF OUTPUT OF THE HERNIATED MATERIAL
A: normal disk.
B: happens one distension of the annulus (fibrous ring), for core displacement, con intervertebral disc protrusion.
C: subsequent radial rupture of the annulus allows the nucleus to protrude completely through the annulus and lodge in front of the longitudinal ligament. you see acontained disc herniation.
D: protrusion of part of the nucleus pulposus through the posterior longitudinal ligament: protruded or expelled or uncontained hernia.
E: In the end, a piece of nucleus pulposus separates and migrates to form asequestered hernia.
CLASSIFICATION IN RELATION TO THE TOPOGRAPHIC SITE IN REFERENCE TO THE DISC AND THE VERTEBRAE WITHIN WHICH IT IS LOCATED
- MEDIAN, when the herniation faces posteriorly along the midline;
- PARAMEDIANA, when the herniation is posterior and slightly deviated laterally from the midline;
- LATERAL, when it is markedly distant from the midline;
- INTRAFORAMINALE, when it affects the conjugation foramen through which the nerve roots passing out of the rachis pass;
- EXTRAFORAMINALE, when the rupture of the annulus occurs in a more lateral point than the conjugation foramen.
CLASSIFICATION IN RELATION TO THE TOPOGRAPHIC SITE IN REFERENCE TO THE RACHIS
- Cervical hernias (you see neck pain)
- Dorsal hernias (you see dorsalgia)
- Lumbar hernias (you see low back pain, sciatica, cruralgia)