intervertebral disc herniation is a very common degenerative disease in clinical, common in lumbar intervertebral disc and cervical intervertebral disc. The generalized intervertebral disc herniation can be divided into four pathological types: bulging type, herniated type, prolapsed type and free type, which correspond to intervertebral disc bulging , intervertebral disc herniation, intervertebral disc herniation and free intervertebral disc in the imaging diagnosis report. How does
distinguish the four types?
intervertebral disc anatomy
intervertebral disc is a fibrocartilage disc that connects two adjacent vertebral bodies. It consists of two parts. The surrounding part is an anulus fibrosis, which is composed of dozens of layers of circular and radial collagen fibers and elastic fibers. The dense tissues arranged in concentric circles are full of toughness, which connects the vertebral bodies tightly and firmly into one body, protects the nucleus pulposus and restricts the nucleus pulposus from protruding to the surrounding.
Figure 1 Schematic diagram of a normal intervertebral disc, the intervertebral disc is composed of the surrounding fibrous annulus and the central nucleus pulposus
Figure 2 The normal intervertebral disc is between two adjacent vertebral bodies, and the periphery does not exceed the edge of the vertebral body
ge1.
The annulus fibrosis is loose but intact, and the nucleus pulposus is shrunken, manifested as the annulus fibrosis evenly exceeds the edge of the vertebral endplate.
Figure 3 The imaging definition of intervertebral disc bulging is defined as the protrusion> 25% of the edge of the intervertebral disc, or the angle between the two sides of the protrusion and the center of the nucleus pulposus> 90°
Clinical manifestations
Sometimes there is no clinical symptoms of vertebral space stenosis. , Instability of the vertebral segments, secondary changes in the articular process, repeated low back pain, rarely radicular symptoms. If it is combined with developmental spinal stenosis, it is manifested as spinal stenosis, and spinal canal decompression should be performed.
2. Disc protrusion (Disc protrusion)
is when the nucleus pulposus protrudes into the annulus fibrosus but the posterior longitudinal ligament is not ruptured. It is manifested as the limitation of the disc protrusion into the spinal canal.
Figure 4 The imaging definition of intervertebral disc herniation is that the herniated part is less than 25% of the edge of the intervertebral disc, and the base> the diameter of the protruded part; the angle between the two sides of the herniated disc and the center of the nucleus is less than 90°
Clinical manifestations:
z0 , Some patients have typical radiculopathy symptoms and signs. This type can be relieved by conservative methods such as traction, bed rest, and focal injection, but due to the poor healing ability of the broken annulus, the recurrence rate is higher.
3. intervertebral disc prolapse (Disc extrusion)
the annulus fibrosus and posterior longitudinal ligament are completely ruptured, and the nucleus pulposus protrudes into the spinal canal.
Figure 5 The imaging of intervertebral disc herniation is defined as the basal part of the herniated disc (A) Clinical manifestations Lumbar disc herniation has more symptoms and pathological types, with obvious signs of lumbar disc herniation. The effect of conservative treatment is relatively poor, and most of them require minimally invasive intervention or surgery. 4. Free intervertebral disc The nucleus pulposus is not connected to the corresponding intervertebral disc, and can be free to the upper or lower segment of the diseased intervertebral disc in the spinal canal, intervertebral foramina , etc. Figure 6 Free intervertebral disc refers to the complete prolapse of the nucleus pulposus and not connected to the intervertebral disc, free in the spinal canal Clinical manifestations Persistent nerve root symptoms or spinal stenosis symptoms, a small number of cauda equina syndrome may occur, this type often requires surgical treatment. This is one of the pathological types of lumbar disc herniation. The first ward of the Orthopedics Department of Nanyang Medical College Affiliated Hospital is a key specialty of clinical medicine in Nanyang City, and the hip and knee replacement department approved by the Henan Provincial Department of Health, with intervertebral disc mirrors, arthroscopes, C-arm X-ray machines, operating microscopes, etc. advanced equipment. Carry out various exercise system diseases diagnosis and treatment projects including bone injury, bone disease, bone tumor , bone tuberculosis, etc. He has rich clinical experience in the diagnosis and treatment of various complex fractures, spinal trauma, joint trauma, soft tissue trauma, congenital deformity, hip replacement, and knee replacement. Spine surgery is a special project of the undergraduate. It has successfully implemented nearly 10,000 cases of anterior and posterior surgery for cervical, thoracic, and lumbar diseases and trauma. In particular, minimally invasive lumbar intervertebral disc surgery is at the leading level in Nanyang. Department name: Orthopedics First Ward Location: Comprehensive Ward Building, Ninth District, North District Tel: 63328373
