It has a four stages-
• Bulging- Only at that early stage, the disc is stretched and completely return to its normal shape when pressure is relieved. It retains a small bulge at one for reds of the disc.A few of the inner disc fibres might be torn and the soft jelly ( nucleus pulposus ) is spiling outwards in to the disc fibres although not out of the disc.
• Protrusion- At this time, the bulge is extremely prominent and the soft jelly centre has spilled to the inner edge of the outer fibres, barely locked in by the remaining disc fibres.
• Extrusion- When it comes to a herniated spinal disc,the soft jelly has completely spilled from the disc and now protruding from the disc fibres.
• sequestration- Here a few of the jelly material is breaking off from the disc into the area.
prolapsed disc (commonly known as a 'slipped disc'), a disc doesn't actually 'slip'.What happens is that area of the inner softer area of the disc (the nucleus pulposus) bulges out (herniates) via a weakness in the outer area of the disc. A PIVD /prolapsed disc may also be called a herniated disc. The bulging disc may press on nearby structures like a nerve coming from the spinal-cord. Some inflammation also develops round the prolapsed part of the disc. Any disc within the spine can prolapse. However, most prolapsed discs exist in the lumbar area of the spine (lower back). How big the prolapse can vary. Usually, the larger the prolapse, the more severe the symptoms could be.Understanding the back
The spine consists of many bones called vertebrae. They are roughly circular and in between each vertebra is a 'disc'. The discs are constructed with strong 'rubber-like' tissue that allows the spine to become fairly flexible. A disc includes a stronger fibrous outer part, along with a softer jelly-like middle part known as the nucleus pulposus. The spinal cord, containing the nerves which come from the brain, remains safe and secure by the spine. Nerves in the spinal cord come out from between your vertebrae to take and receive messages to numerous parts of the body. Strong ligaments affix to the vertebrae. These give extra support and strength towards the spine. Various muscles also surround, and therefore are attached to, various parts from the spine.
Anatomy of Intervertebral discs
Intervertebral Discs are soft, rubbery pads found between your hard bones (vertebrae) that comprise the spinal column. The spinal canal is really a hollow space in the center of the spinal column which has the spinal cord along with other nerve roots. The discs between your vertebrae allow the to flex or bend. Discs also behave as shock absorbers.Normal anatomy of lumbar spine. Discs within the lumbar spine (mid back) are composed of a thick outer ring of cartilage (annulus fibrosus) as well as an inner gel-like substance (nucleus pulposus). Within the cervical spine(neck), the discs offer a similar experience but smaller in dimensions. Two layers of cartilage that go over top and bottom aspect of each disc called avertebral end plate. Its separate the disc in the adjacent vertebral body.
nucleus pulposus It's semi fluid mass of mucoid material appears like a toothpaste. It contain few cartilage cells and irregular arranged collagen fibers. The fluid nature of nucleus pulposus allowed so that it is deformed under pressure. The nucleus make an effort to deformed and will there by transmit the applied pressure in most direction.
annulus fibrosus The annulus fibrosus contain collagen fibers. The collagen fibers are arranged among 10 to 20 sheets called lamellae. They are arranged in concentric rings that surround the nucleus pulposus. They're thick in anterior and lateral area of the annulus but posteriorly they are finer and much more tightly packed.The collagen fibers lie parellel to one another. Posterior portion of annulus fibrosus is innervated by fibres of sinuvertebral nerve (branch of dorsal root ganglion). Irritation from the sinuvertebral nerve is responsible for axial lower back pain.
Vertebral End Plates Each vertebral end plate is really a layer of cartilage about 0.6-1 mm thick. Covers the region on the vertebral area encircled through the ring apophysis. Nucleus pulposus is entirely covered but annulus fibrosus is just 66% covered by the end plates.
Kinds of herniation
• central
• paramedial
• lateral
Causes of PIVD
• Heavy manual labour
• Repetitive lifting and twisting
• Postural stress
• obesity
• Poor and inadequate strength from the trunk
• Sitting for long hours
• increasing age (a disc is much more likely to develop a weakness with increasing age)
Symptoms of PIVD
Lower Back /Lumbar Herniated Disc Symptoms
• Severe low-back pain
• Pain radiating towards the buttocks, legs, and feet
• Pain compounded with coughing, straining or laughing
• Muscle spasm
• Tingling or numbness in legs or feet
• Muscle weakness or atrophy in later stages
• Loss of bladder or bowel control in the event of cauda equina syndrome
Some people do not have the signs of PIVD Research studies where routine back scans happen to be done on a many people have shown that many people have a PIVD without any symptoms. It's thought that symptoms mainly occur when the prolapse causes pressure or irritation of the nerve. This does not take place in all cases. Some prolapses might be small, or occur from the nerves and cause minor, or no symptoms.
Neck /Cervical Herniated Disc Symptoms
• Arm muscle weakness
• Deep pain near or higher the shoulder blades around the affected side
• Increased pain when bending the neck or turning go to the side
• Pain made worse with coughing, straining or laughing
• Neck pain, particularly in the back and sides together with spasm
• Burning pain radiating to the shoulder, upper arm, forearm, and rarely the hand, fingers or chest
• Tingling (a "pins-and-needles" sensation) or numbness in a single arm
Cauda equina syndrome - rare, but an urgent situation
Cauda equina syndrome is a particularly serious kind of nerve root problem that may be caused by a prolapsed disc. This can be a rare disorder in which the nerves at the very bottom from the spinal cord are pressed on. This syndrome may cause low back pain plus: issues with bowel and bladder function (usually not able to pass urine), numbness within the 'saddle' area (around the anus), and weakness in a single or both legs. This syndrome needs urgent treatment to preserve the nerves towards the bladder and bowel from becoming permanently damaged. Visit a doctor immediately should you develop these symptoms.
Bulging Discs vs. Herniated Discs
The main difference between bulging discs and herniated discs are whether or not they are contained or non-contained:
A contained disc- like a bulging disc, hasn't broken through the outer wall from the intervertebral disc, which means the nucleus pulposus remains contained inside the annulus fibrosus.
A non-contained disc- such as a herniated or ruptured disc, has either partially or completely broken with the outer wall from the intervertebral disc.A bulging disc can be a precursor to a herniation. The disc may protrude in to the spinal canal having to break through the disc wall. The gel-like interior (nucleus pulposus) doesn't leak out. The disc remains intact except a little bubble appears externally the disc. Whenever a disc herniates, the contents may compress the spinal-cord or the spinal nerve roots.To complicate things, sometimes fragments in the annulus (the outer disc wall) may breakaway in the parent disc and drift in to the spinal canal.
Tests for PIVD
Special Tests for PIVD-
• SLR test
• Laesegue test
• Bowstring test
• Femoral stretch test
Your physician will normally be able to diagnose a PIVD in the symptoms and by examining you. (It's the common cause of sudden lower back pain with nerve root symptoms). Generally of PIVD, tests for example x-rays or scans my be advised if symptoms persist. Particularly, an MRI scan can display the site and size a prolapsed disc. This post is needed if treatment with surgical treatment is being considered.
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