Intervertebral Discs and Radiculopathy
Pathogenesis
Displaced disc material bulges beneath annulus fibrosus or extrudes through tear in annulus, projecting directly into spinal canal (herniated disc). Compresses nerve roots, spinal cord, or both (cord involved only in cervical or thoracic region).
Most commonly affected: C5 to C7 segments in cervical region; L4 to L5 and L5 to S1 in lumbar region (Table 66.1).
Causes of disc herniation: trauma, genetic predisposition. Nerve compression also with spinal stenosis, spondylosis, osteoarthritis.
Incidence
Ruptured intervertebral disc common: peak in fourth to sixth decades; rare before age 25 or after 60. Eighty percent men.
Lumbar Intervertebral Disc Rupture
Pain: limited to back or in root distribution; episodic; aggravated by Valsalva maneuvers (sneezing, coughing, straining at stool), heavy lifting, bending or twisting spine; relieved by lying down, worse on standing. Paresthesias in radicular distribution. Typical syndromes in Table 66.1.
Examination: loss of lumbar lordosis, splinting (spine tilted), reduced motion of spine (cannot bend forward to touch toes). Local vertebrae tender. Passive straight-leg raising increases pain.
Thoracic Disc Rupture
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