Intervertebral disc conditions
In this section we are going to talk exclusively about intervertebral discs and the many things that can go wrong with them. Degenerative discs are one of the most common sources of back pain so we will spend much of our time speaking about degenerative discs. We will also touch on traumatic disc injuries such as those that occur during sports injuries and infective causes of disc pain. We will use a lot of technical language in this section however still try to keep it easy to read and understand.
Intervertebral disc degeneration and intervertebral discogenic pain can be a constant and persistent course of neck and back pain. Intervertebral discs will heal however a correct diagnosis and treatment is crucial to improving discogenic back and neck pain. At Sydney Spine & Sports Centre (S3C) we are an intervertebral disc pain treatment centre of excellence, located in Balmain and Rozelle, Sydney.
Degenerative discs (technical)
A degenerative intervertebral disc is a collective term that is used to broadly describe the changes within an intervertebral disc. These changes may occur during the normal ageing process or be sped up with lifestyle, sporting, occupations and hereditary factors. Inflammatory diseases, chronic wear and tear, and cancer that affect the disc could certainly speed this degeneration (break down) up too. These are known as pathological changes. For a disc to be termed or classed as degenerative there are three things that must be seen. One or all of these subcategories should be seen, and include. Intervertebral disc annular fissures, intervertebral disc degeneration, and intervertebral disc herniation
Degenerative discs (non-technical)
The term degenerative disc simply implies that the disc has lost some of its structural integrity. The disc has broken down to some degree. This will happen to all of us. Changes can be normal or pathological. Normal changes occur form the process of ageing (everyone). Pathological changes occur from disease (not everyone). Degenerative disc usually have tears (fissures), herniations (slipped discs) and other sings of degeneration such as extreme dryness (lost moisture within). Degenerative discs may or may not be painful. Back and neck pain coming from degenerative disc is very complicated.
Normal Vs. pathological disc changes
In this section we will try to remove some myths about spinal degeneration and what is considered normal and abnormal in regards to the spine. MRI scans and CT scans are the best way to image and visualise the spine for degeneration. When you see the word normal on MRI and CT scan reports, this means the disc does not have any changes related to a disease, trauma or even normal aging. No changes, period. The disc looks like a million bucks. In anyone over 25 years of age, this is not typical. We will all age, we will all get wrinkles on the skin, and we will all get some signs on ageing in the spine and the intervertebral discs.
A disc bulge is refers to a general extension of the whole circumference of a disc beyond the border in which it usually sits. This border is called the apophyseal ring. A bulging disc is just a squashed disc that radiations out in all directions around the disc. Technically more the 25% of its circumference needs to bulge out to be termed a disc bugle. Generally speaking most disc bulges only stick out less than 3mm. Disc herniation is not the same as disc bulge. Sydney Spine & Sports Centre (S3C) is a chiropractic and physiotherapy treatment centre of excellence in Balmain and Rozelle. We use treatments that are of the highest standard, safe and effective.
Intervertebral disc herniation (disc herniation) is a collective term used to describe the displacement of disc material beyond where the intervertebral disc is normally meant to sit. The intervertebral disc is meant to sit in the intervertebral space. The intervertebral space is formed by the vertebral bones above and below (end plates) and the ring apophysis around the edges of the disc. The ring apophysis is where the outer layers of the disc (annulus) are joined to the vertebral bones above and below (traces around the edge of the disc). More than one herniation can occur simultaneously. A herniation may complicate other pre-existing abnormalities such as degenerative vertebrae changes and fractures. Herniations are subcategorised as either a protrusion or extrusion.
A disc protrusion is a type of disc herniation. Disc herniation is a collective term that includes a disc protrusion and a disc extrusion. A disc protrusion is described as a local or focal area of a disc (less than 25% of the disc) that has extended beyond where the disc usually sits (apophyseal ring). This area of disc protrusion is bigger at its start then the end (part poking out) and no disc material has broken off into the spine.
An extruded disc is a type of herniated disc. A herniated disc describes both disc protrusions and extrusions. An extruded disc is defined as a local area of the disc that has extended beyond where the disc usually sits (apophyseal ring). Opposite to a disc protrusion, in a disc extrusion there is more disc material pocking out of the disc at the then within the disc at the start of the extrusion. This means more material has come out compared to a disc protrusion. A subcategory of a disc extrusion is a disc sequestration, this occurs when they end of the disc extrusion breaks off and is no longer continuous with the rest of the extrusion. Sometimes people say the sequestrated disc has ‘migrated’. This means it’s moved away.
A disc sequestration is a subcategory of a disc extrusion. These are all types of disc herniations. A disc sequestration occurs when a portion of a disc extrusion (herniation) breaks off and lodges in the spinal column. When a fragment breaks of the herniated disc, this is sometimes called a ‘free fragment’. This is a medical emergency in the neck and back as it can cause lasting neurological problems. At Sydney Spine & Sports Centre (S3C) chiropractors and physiotherapists offer you all the information and education we can in order to empower you about your spine, health and wellbeing.
Contained and uncontained discs
There is an increasing reference to intervertebral disc herniations as contained (subligamentous) or uncontained. This is a rather nice and simple way to categorise disc herniations. A contained herniated disc is a herniated disc where the displaced portion is covered by the outer annulus fibres and/or the posterior longitudinal ligament. An uncontained herniated disc is a herniated disc where the displaced portion of the disc does not have a covering.
High intensity zones
High intensity zones are certain areas within an intervertebral disc that are brighter than others on MRI. They are bright signs on MRI (T2W) that indicate a tear (fissure) within the outer area (annulus) of an intervertebral disc. These zones become brighter due to the accumulation of repair tissue within a disc (granulation tissue) and the waste products (injured tissues) following the injury (truma) or degeneration (getting old).
Black discs on MRI
Disc dehydration (desiccation) will produce ‘black discs’ on MRI. Disc desiccation simply means intervertebral disc have become dehydrated and aged. This will happen to us all to some degree, and is a typical part of aging. When a disc becomes dehydrated it is very likely that there is at least one tear within the disc. The more injuries (wear and tear) to a disc, the more tears (fissures) will develop and the more disc dehydration will occur. Technically speaking, dehydrated discs represent a structural change within a disc, a ‘hard’ substance called fibrocartilage replaces our ‘spongy’ substance called glycosaminoglycans.
Disc (intervertebral disc) fissures were once called disc tears because that’s what they are. Disc fissures are tears within a disc. They are no longer called tears. It was thought that the term ‘disc tear’ implied that there had been a traumatic cause, such as whiplash accident or a fall. Disc fissures can certainly occur during a traumatic incident however the vast majority occur as a result of degeneration. Disc degeneration implies that the disc has slowly broken down over time. It is thought that disc degeneration happens as a result of mechanical factors (heavy lifting occupations), nutritional factors (disc not getting nutrients for repair), and hereditary factors (genetically not a tough disc). Almost all degenerated disc contain disc tears.
Disc (intervertebral disc) fissures were once called disc tears because that’s what they are. Disc fissures are tears within a disc. They are no longer called tears. It was thought that the term ‘disc tear’ implied that there had been a traumatic cause, such as whiplash accident or a fall. Disc tears can certainly occur during a traumatic incident however the vast majority occur as a result of degeneration. Sydney Spine & Sports Centre (S3C) is a chiropractic and physiotherapy centre of excellence located in Balmain and Rozelle. We use evidence based treatments that are safe, reliable and effective.
Intervertebral disc can become inflamed and infected. This is called inflammatory discitis or infection discitis, when a disc is infected and is an extremely serious condition. Other causes of discitis include inflammatory responses to spondyloarthropathies. Our chiropractors and physiotherapists discuss these in full in the neck and low back pain pages with this condition section of the website.
Traumatic disc injury
Traumatic disc injury really describes a disc injury that has occurred from a violent physical trauma. This occurs in situation on the sporting field, falls, car accidents and similar accidents. Traumatic disc injury doesn’t include injuries to a disc that have already been broken down by degeneration or previous herniation. Sydney Spine & Sports Centre (S3C) is a chiropractic and physiotherapy centre of excellence located in Balmain and Rozelle. We use evidence based treatments that are safe, reliable and effective.