From the Guidelines
A disc issue in the spine refers to a problem with the intervertebral disc, which can include herniation, protrusion, or degeneration, leading to compression of adjacent nerve roots or other structures.
Common Disc Issues
- Herniated disc: Herniation of the nucleus pulposus of an intervertebral disc through its fibrous outer covering, which can result in compression of adjacent nerve roots or other structures 1.
- Disc protrusion: A condition where the disc bulges out of its normal position, which can cause pain and discomfort.
- Degenerative disc disease: A condition where the disc loses its height and flexibility, leading to pain and stiffness in the spine.
Diagnosis and Treatment
- Imaging studies such as MRI or CT scans are often used to diagnose disc issues, but are not always necessary for patients with acute low back pain without red flags 2.
- Treatment options for disc issues include medical management, physical therapy, and in some cases, surgery or epidural steroid injections 3.
Important Considerations
- Nonspecific lumbar disc abnormalities are common in asymptomatic patients, and can be demonstrated readily on MRI, CT, fluoroscopic myelography, and postmyelography CT of the lumbar spine 2.
- Imaging abnormalities can be seen in a substantial number of people without back pain, and the presence of these abnormalities does not necessarily mean that they are the cause of the patient's symptoms 2.
From the Research
Definition and Composition of Intervertebral Discs
- The intervertebral disc (IVD) is a soft tissue that constitutes the spinal column together with the vertebrae, consisting of the central nucleus pulposus (gelatinous tissue) and the annulus fibrosus (rich in fibrous tissue) that surrounds the nucleus pulposus 4.
- Intervertebral discs are a crucial component of the spine, playing a key role in spinal flexibility and movement.
Intervertebral Disc Issues
- Intervertebral disc degeneration is associated with various morphological changes, such as reduction of the water content, collapse of the intervertebral space, disruption and tears, and osteophytes 5.
- Degenerative changes of the intervertebral disc can lead to subtle alterations of the mechanical properties of the functional spinal unit, resulting in spinal stiffening with increasing degeneration 5.
- Intervertebral disc herniation (IDH) can cause back pain and/or radiculopathy, accounting for a significant portion of patients having spinal surgery 6.
- Intervertebral disc diseases are the leading cause of lower back pain and disability, with a high prevalence of asymptomatic intervertebral disc diseases 7.
Diagnosis and Treatment
- Diagnostic tests currently available for diagnosis of a painful disc are inadequate, and treatment protocols for low back pain generally ignore the presence of a painful disc 8.
- Recent developments in radiological and biomarker investigations have potential to provide noninvasive alternatives to the gold standard, invasive discogram 7.
- Management of intervertebral disc diseases can be categorized into five headings: relief of pain by conservative management, restorative treatment by molecular therapy, reconstructive treatment by percutaneous intervertebral disc techniques, relieving compression and replacement surgery, and rigid fusion surgery 7.