Generalized extension of disc beyond edges of vertebral ring apophyses
> 25% of disc circumference
Typically extends < 3 mm beyond edge of apophyses
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Nonvascular Interventions
Nuclear Medicine Findings
Other Modality Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Image Interpretation Pearls
Selected References
Li Y et al: How should we grade lumbar disc herniation and nerve root compression? A systematic review. Clin Orthop Relat Res. 473(6):1896-902, 2015
Fardon DF et al: Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology, and the American Society of Neuroradiology. Spine (Phila Pa 1976). 39(24):E1448-65, 2014
Hadjipavlou AG et al: The pathophysiology of disc degeneration: a critical review. J Bone Joint Surg Br. 90(10):1261-70, 2008
Walker J 3rd et al: Discography in practice: a clinical and historical review. Curr Rev Musculoskelet Med. 1(2):69-83, 2008
Modic MT et al: Lumbar degenerative disk disease. Radiology. 245(1):43-61, 2007
Urban JP et al: Pathophysiology of the intervertebral disc and the challenges for MRI. J Magn Reson Imaging. 25(2):419-32, 2007
Ido K et al: The validity of upright myelography for diagnosing lumbar disc herniation. Clin Neurol Neurosurg. 104(1):30-5, 2002
Lebkowski WJ et al: Degenerated lumbar intervertebral disc. A morphological study. Pol J Pathol. 53(2):83-6, 2002
Botwin KP et al: Role of weight-bearing flexion and extension myelography in evaluating the intervertebral disc. Am J Phys Med Rehabil. 80(4):289-95, 2001
Fredericson M et al: Changes in posterior disc bulging and intervertebral foraminal size associated with flexion-extension movement: a comparison between L4-5 and L5-S1 levels in normal subjects. Spine J. 1(1):10-7, 2001
Adams MA et al: Mechanical initiation of intervertebral disc degeneration. Spine. 25(13):1625-36, 2000
Luoma K et al: Low back pain in relation to lumbar disc degeneration. Spine. 25(4):487-92, 2000
Milette PC et al: Differentiating lumbar disc protrusions, disc bulges, and discs with normal contour but abnormal signal intensity. Magnetic resonance imaging with discographic correlations. Spine. 24(1):44-53, 1999
Sambrook PN et al: Genetic influences on cervical and lumbar disc degeneration: a magnetic resonance imaging study in twins. Arthritis Rheum. 42(2):366-72, 1999
Harada A et al: Correlation between bone mineral density and intervertebral disc degeneration. Spine. 23(8):857-61; discussion 862, 1998
Cowan NC et al: The natural history of sciatica: a prospective radiological study. Clin Radiol. 46(1):7-12, 1992
Maezawa S et al: Pain provocation at lumbar discography as analyzed by computed tomography/discography. Spine. 17(11):1309-15, 1992
Ito S et al: An observation of ruptured annulus fibrosus in lumbar discs. J Spinal Disord. 4(4):462-6, 1991
Bernard TN Jr: Lumbar discography followed by computed tomography. Refining the diagnosis of low-back pain. Spine. 15(7):690-707, 1990
Tervonen O et al: Lumbar disc degeneration. Correlation between CT and CT/discography. Acta Radiol. 31(6):551-4, 1990
Kambin P et al: Annular protrusion: pathophysiology and roentgenographic appearance. Spine. 13(6):671-5, 1988
Sachs BL et al: Dallas discogram description. A new classification of CT/discography in low-back disorders. Spine. 12(3):287-94, 1987
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Synonyms
Anular bulge, annular bulge, bulging disc
Definitions
Generalized extension of disc beyond edges of vertebral ring apophyses
> 25% of disc circumference
Typically extends < 3 mm beyond edge of apophyses
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Nonvascular Interventions
Nuclear Medicine Findings
Other Modality Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Image Interpretation Pearls
Selected References
Li Y et al: How should we grade lumbar disc herniation and nerve root compression? A systematic review. Clin Orthop Relat Res. 473(6):1896-902, 2015
Fardon DF et al: Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology, and the American Society of Neuroradiology. Spine (Phila Pa 1976). 39(24):E1448-65, 2014
Hadjipavlou AG et al: The pathophysiology of disc degeneration: a critical review. J Bone Joint Surg Br. 90(10):1261-70, 2008
Walker J 3rd et al: Discography in practice: a clinical and historical review. Curr Rev Musculoskelet Med. 1(2):69-83, 2008
Modic MT et al: Lumbar degenerative disk disease. Radiology. 245(1):43-61, 2007
Urban JP et al: Pathophysiology of the intervertebral disc and the challenges for MRI. J Magn Reson Imaging. 25(2):419-32, 2007
Ido K et al: The validity of upright myelography for diagnosing lumbar disc herniation. Clin Neurol Neurosurg. 104(1):30-5, 2002
Lebkowski WJ et al: Degenerated lumbar intervertebral disc. A morphological study. Pol J Pathol. 53(2):83-6, 2002
Botwin KP et al: Role of weight-bearing flexion and extension myelography in evaluating the intervertebral disc. Am J Phys Med Rehabil. 80(4):289-95, 2001
Fredericson M et al: Changes in posterior disc bulging and intervertebral foraminal size associated with flexion-extension movement: a comparison between L4-5 and L5-S1 levels in normal subjects. Spine J. 1(1):10-7, 2001
Adams MA et al: Mechanical initiation of intervertebral disc degeneration. Spine. 25(13):1625-36, 2000
Luoma K et al: Low back pain in relation to lumbar disc degeneration. Spine. 25(4):487-92, 2000
Milette PC et al: Differentiating lumbar disc protrusions, disc bulges, and discs with normal contour but abnormal signal intensity. Magnetic resonance imaging with discographic correlations. Spine. 24(1):44-53, 1999
Sambrook PN et al: Genetic influences on cervical and lumbar disc degeneration: a magnetic resonance imaging study in twins. Arthritis Rheum. 42(2):366-72, 1999
Harada A et al: Correlation between bone mineral density and intervertebral disc degeneration. Spine. 23(8):857-61; discussion 862, 1998
Cowan NC et al: The natural history of sciatica: a prospective radiological study. Clin Radiol. 46(1):7-12, 1992
Maezawa S et al: Pain provocation at lumbar discography as analyzed by computed tomography/discography. Spine. 17(11):1309-15, 1992
Ito S et al: An observation of ruptured annulus fibrosus in lumbar discs. J Spinal Disord. 4(4):462-6, 1991
Bernard TN Jr: Lumbar discography followed by computed tomography. Refining the diagnosis of low-back pain. Spine. 15(7):690-707, 1990
Tervonen O et al: Lumbar disc degeneration. Correlation between CT and CT/discography. Acta Radiol. 31(6):551-4, 1990
Kambin P et al: Annular protrusion: pathophysiology and roentgenographic appearance. Spine. 13(6):671-5, 1988
Sachs BL et al: Dallas discogram description. A new classification of CT/discography in low-back disorders. Spine. 12(3):287-94, 1987
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