Pathology of

Intervertebral Disk
Sana kiani
Pathology of Intervertebral

There are several pathologies of intervertebral disk, it may include:

 Prolapse

 Protrusion

 Extrusion/Herniation

 Free sequestration
Anterior herniation usually is asymptomatic; posterior herniation puts
pressure on nerve roots or spinal canal and produces symptoms.

Posterior herniation present in 50% of older individuals, usually in

lumbar spine Herniation refers to either prolapse, protrusion or
extrusion.
Protrusion:
Bulging of nucleus pulposus through weakened annulus fibrosus, usually
posterior or posteriolateral Can rarely disappear.

Prolapse:
Rupture of nucleus pulposus through annulus but not the posterior or
anterior longitudinal ligament.

Associated with neovascularization at edges of fibro cartilaginous

fragments.

Usually in lumbar region but may occur in thoracic or cervical disc.

Extrusion:
Rupture of nucleus pulposus through annulus and posterior or anterior
longitudinal ligament.

Sequestration:
Fragmentation of extruded segment, may extend into spinal canal or far
from site of rupture.

Clinical symptoms depend on severity of herniation and position of

offending disc.

Patient may develop cauda equina syndrome in severe cases.

Symptoms of degenerative disk disease:

The most common symptoms of degenerative disk disease are neck pain
and back pain. Pain may be experience as:

Comes and goes, lasting for weeks or months at a time. Leads to

numbness or tingling in the arms or legs.

Radiates down to buttocks and lower back.

Worsens with sitting, bending or lifting.

Causes degenerative disk disease:

Spinal disks wear down as a normal part of aging.

Especially after age 40, most people experience some disk degeneration.
However, not everyone experiences pain.

The pain might feel if spinal disk:

Dry out: The water content of the disk will naturally loose some water,
As a result, disks get thinner and don’t provide as much shock absorption
as they used to.
Tear or crack:

Minor injuries can lead to small cracks in the spinal disks. These tears
are often near nerves.

Tears can be painful, even when they are minor. If the outer wall of the
spinal disk cracks open, The disk may bulge out of place, known as a
herniated disk, which may compress a spinal nerve. May start and stop.

Can get worse after certain activities such as bending, twisting or lifting.

Can get worse over time.

Diagnosis of degenerative disk disease

To diagnose degenerative disk disease, The questions may include:

When does the pain start?

Where do you feel pain?

What activities cause the most pain?

What activities decrease the pain?

Did you have an injury or accident that led to pain?

Do you have other symptoms, such as tingling or numbness?

How far can you walk?

imaging can also be used such as:
X-ray,
CT
MRI.

The physical exam to check:

Nerve function: This may use a reflex hammer to check the reactions.
Poor or no reaction could mean patient have damaged or compressed
nerves.

Pain levels: To measure the pain levels the therapist can touch or press on
specific areas of the back.
MANAGEMENT AND TREATMENT

The treatment may include:

Physical therapy: Participating in strengthening and stretching

exercises.

Medications: Taking non-steroidal anti-inflammatory drugs (NSAIDs),

muscle relaxers or steroids.

Steroid injections: Injecting medicine near the spinal nerves, disk or

joints to reduce inflammation and pain.
Radiofrequency neurotomy: Using electric currents to burn sensory
nerves and prevent pain signals from reaching the brain.

The home remedies may help but may decrease pain for a short period
of time but they are not a long-term treatment for severely degenerated
disks.
Exercise: Low-impact activity such as walking or swimming can
strengthen back muscles and relieve some pain.

Hot and cold therapy: Alternating ice packs and heating pads every 10
to 15 minutes up to three to four times per day may reduce soreness and
inflammation.

Stretching: Gentle yoga and stretching throughout the day may improve
posture and relieve tension.
Prevention of degenerative disk disease:

The spinal degeneration can prevent or slow its progression through

lifestyle changes, some of these include:

Achieving and maintaining a healthy body weight.

Avoiding or quitting smoking.

Exercising regularly to increase strength and flexibility.

Segmental Instability

Segmental instability refers to hypermobility or greater than normal

range of motion between two vertebral motion segments.

This condition often develops when a particular disc or facet joint

degenerates to the point that it can no longer support the weight of the
body through that segment of the spine.
Symptoms of spinal instability

The symptoms of spinal instability include:

Burning pain and/or spasms in the back or buttocks.

Leg weakness, Pain, numbness, or tingling in the legs.

Back and/or leg pain that is worse with activity and improves or is
eliminated with rest.
Severe pain in the back while lifting objects, bending and straightening
the spine.

A feeling of locking in between a physical activity such as getting up

from a chair.

Muscle spasms, Pain may radiate down into the legs and buttocks,
generally affecting one side of the body, Numbness in the lower
extremities and arms

The symptoms may get aggravated after prolonged sitting or standing

Laughing, coughing or sneezing may also induce pain

This causes the vertebrae to displace from their anatomical position. It
eventually produces friction between the vertebrae, causing pain and
several other symptoms.

The micro movement within the spine irritates the nerves that emerge
out of the joint spaces. The condition may increase the risk of Spinal
Arthritis and development of bone spurs. Spinal Instability may also
affect the ability of the spine to maintain the body’s structure and
movement.
Causes

External trauma or fracture of the spine

Metastatic tumors in the spine

Degenerative Disc Disease

Congenital defects in the spinal cord

Scoliosis

Spondylolisthesis

Disorders of the connective tissues

Poor lifting techniques

Details of the patient’s medical history and lifestyle may be noted
down .

MRI and CT scan may also help.

Bending and straightening the spine X-ray imaging may be required to

study the changes in the bone structure.
Treatment

Physical therapy may be effective in treating mild Spinal Instability as it

focuses on strengthening the muscles in the spine. Pain killers and anti-
inflammatory medicines may be prescribed by the doctor.

Micro discectomy- Surgical removal of the intervertebral disc that is

impinging on the spinal nerve

Spinal Instability or Lumbar Instability is a condition that occurs when

the inter-vertebral discs in the spine begin to degenerate.
 Spinal Fusion
Two or more spinal vertebrae are fused together to prevent any

movement between them.

 Spinal stenosis

Spinal stenosis is most commonly caused by wear-and-tear changes in

the spine related to osteoarthritis.

In severe cases of spinal stenosis, doctors may recommend surgery to

create additional space for the spinal cord or nerves.
Types of spinal stenosis:
The types of spinal stenosis are classified according to the suite of
condition occurs. The two main types of spinal stenosis are :

Cervical stenosis:

In this condition, the narrowing occurs in the cervical region.

Lumbar stenosis:

In this condition, the narrowing occurs in the lumber region , It's the
most common form of spinal stenosis.
Symptoms :
Many people have evidence of spinal stenosis on an MRI or CT scan but may not
have symptoms.

The symptoms starts gradually and worsen over time.

Symptoms vary depending on the location of the stenosis and which nerves are
affected.

In the neck (cervical spine):

Numbness or tingling in a hand, arm, foot or leg

Weakness in a hand, arm, foot or leg

Problems with walking and balance

Neck pain
In severe cases, bowel or bladder dysfunction (urinary urgency and
incontinence)

In the lower back (lumbar spine)

Numbness or tingling in a foot or leg

Weakness in a foot or leg

Pain or cramping in one or both legs when you stand for long periods of
time or when you walk.

Back pain
Spinal stenosis exercises:

Exercise, along with good eating habits, can help you slim down if you’re
overweight. This will ease the strain on your spine.

The exercises are most beneficial even after surgery .

Gain flexibility: Stretching exercises can help with pain and make it
easier to hold and move your neck and spine in healthier ways.
Strengthen your muscles:

A series of exercises called stabilization training can help build up the

muscles that support your neck and give them better balance.

To improve body fitness , aerobic exercises are the best choice.

Examples of aerobic exercise include bicycling or swimming.

Pathology of facet joint
Facet joint sprain:

During certain movements of the spine, stretching or compressive forces

are placed on the facet joint.

If these forces are excessive that the facet joint can bare , the injury to
the facet joint may occur.

This may involve damage to the cartilage or tearing to the connective

tissue surrounding the joint.
Causes of a facet joint sprain:

Facet joint sprains typically occur during excessive bending, lifting or

twisting.

They may occur traumatically or due to repetitive or prolonged forces.

Signs and symptoms of a facet joint sprain:

A sudden onset of back pain during the activity.

Pain and stiffness is commonly felt after activity , particularly the next
morning.

Symptoms are typically felt on one side of the spine and muscle spasm
may be experienced around the affected joint.

Occasionally pain may be referred into the buttocks or lower limb on the
affected side.
Symptoms are generally exacerbated with activities that involve
twisting, lifting, backwards, bending forwards or sideways or sitting for
prolonged periods of time.
Diagnosis of a facet joint sprain:

A thorough subjective and objective examination from a physiotherapist

is usually sufficient to diagnose a facet joint sprain. Investigations such
as an MRI or CT scan may be required to confirm diagnosis.
Treatment for a facet joint sprain:
An appropriate physiotherapy program .

Back brace may be required that will help in healing process in the
absence of further tissue damage .

Sitting for prolonged periods should be avoided.

Optimal sitting posture is important to minimize stress on the facet joint.

If you sit slouched, your lower back goes into its maximal bend (similar to
standing and touching your toes) this may aggravate a facet joint.
Optimal sitting posture can be obtained by sitting tall on an appropriate
chair, with your bottom in the back of the chair and a lumbar supported.
Your shoulders should be back and your chin should be tucked in slightly.

The R.I.C.E. regime for a sprained facet joint primarily involves resting
from aggravating activities (this may include the use of a protective brace)
and regular icing.

Anti-inflammatory medication may also significantly fasten the healing

process by reducing the pain and swelling associated with inflammation.

strength exercises to prevent stiffness and weakness and to ensure the

facet joint is functioning correctly.
Soft tissue massage

Electrotherapy

Mobilization

The use of a lumbar roll for sitting

Activity modification advice

Biomechanical correction

Hydrotherapy

Exercises to improve flexibility, strength, posture and core stability

A gradual return to activity

Prognosis of a facet joint sprain:

The recovery time for a facet joint sprain may vary from patient to
patient depending on compliance with physiotherapy.

With ideal treatment, patients may be pain free in as little as several

days or this may take 2-3 weeks.

The injured tissue takes approximately six weeks to restore its strength.
 Physiotherapy for a facet joint sprain

Physiotherapy for a facet joint sprain can fasten the healing process.

Treatment may comprise:

Soft tissue massage

Electrotherapy

Mobilization

The use of a back brace

The use of a lumbar roll for sitting

Activity modification advice

Biomechanical correction

Hydrotherapy

Exercises to improve flexibility, strength, posture and core stability

A gradual return to activity

 Contributing factors to the development of a facet joint sprain

There are several factors that may be assessed and corrected by

physiotherapist .

Poor posture

Lumbar spine stiffness

A sedentary lifestyle

Poor core stability

Muscle weakness or tightness

Inappropriate lifting technique

Being overweight

A lifestyle involving large amounts of sitting, bending or lifting