Podcast
Questions and Answers
What is the outer layer of the disc composed of?
What is the outer layer of the disc composed of?
What is the main component of the nucleus pulposus?
What is the main component of the nucleus pulposus?
In which direction does herniation occur through the cancellous bone of superjacent and interjacent bodies?
In which direction does herniation occur through the cancellous bone of superjacent and interjacent bodies?
What is the effect of anterior herniation on the surrounding structures?
What is the effect of anterior herniation on the surrounding structures?
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What is the most common direction of lumbar disc herniation?
What is the most common direction of lumbar disc herniation?
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What is the effect of direct posterior herniation on the neural structures?
What is the effect of direct posterior herniation on the neural structures?
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What is the result of a large herniation in the direct posterior direction?
What is the result of a large herniation in the direct posterior direction?
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What is the effect of posterolateral herniation on the neural structures?
What is the effect of posterolateral herniation on the neural structures?
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Study Notes
Structure of the Disc
- The disc lies between two vertebral end plates, separating it from the vertebral body above and below.
- The disc consists of two main parts: an outer fibrous coat (annulus fibrosus) and an inner gelatinous core (nucleus pulposus).
- The annulus fibrosus is formed of concentric lamellae of yellow elastic fibers rich in collagen.
- The nucleus pulposus is a mucopolysaccharide-protein complex that is rich in water (80% of its content).
Direction of Herniation
- Herniation can occur in four directions: anterior, posterior, upward, or downward.
- Upward or downward herniation occurs through the cancellous bone of superjacent and interjacent bodies, resulting in Shmorl's nodules.
- Anterior herniation occurs in the retroperitoneal space, having a negligible compressing effect due to the elastic structure.
- Posterior direction is the most important direction of lumbar disc herniation, which can be either direct posterior or posteriolateral.
Posterior Herniation
- Direct posterior herniation: compresses the thecal sac (neural tube), which may affect all cauda equina roots if severely compressed (cauda equina syndrome).
- Posterolateral herniation: affects only the offending nerve root, resulting in most cases a single affected nerve root.
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Description
Learn about the structure and composition of the intervertebral disc, including the annulus fibrosus and nucleus pulposus, and how herniation can occur.
