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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
TERMINOLOGY
Synonyms
- Nonstandard: Herniated nucleus pulposus, slipped or prolapsed disc
Definitions
- Localized (< 25% of disc circumference) displacement of disc material beyond confines of disc space
- Protrusion
- Herniated disc with broad base at parent disc
- Greatest dimension of disc herniation in any plane ≤ distance between edges of base in same plane
- Herniated disc with broad base at parent disc
- Extrusion
- Herniated disc with narrow base or no base at parent disc
- Greatest dimension of disc herniation in any plane > distance between edges of base in same plane
- Herniated disc with narrow base or no base at parent disc
- Sequestered: Free fragment
- Extruded disc without continuity to parent disc
- Migrated
- Disc material displaced away from site of herniation
- Regardless of continuity
- Intravertebral herniation: Schmorl node (endplate herniation)
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Nonvascular Interventions
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
- Carlson BB et al: Lumbar disc herniation: what has the Spine Patient Outcomes Research Trial taught us? Int Orthop. 43(4):853-9, 2019
- Clark R et al: Surgical management of lumbar radiculopathy: a systematic review. J Gen Intern Med. 35(3):855-64, 2019
- Marcia S et al: Image-guided percutaneous treatment of lumbar stenosis and disc degeneration. Neuroimaging Clin N Am. 29(4):563-80, 2019
- El Barzouhi A et al: Reliability of gadolinium-enhanced magnetic resonance imaging findings and their correlation with clinical outcome in patients with sciatica. Spine J. 14(11):2598-60, 2014
- Fardon DF et al: Lumbar disc nomenclature: version 2.0. spine J. 14(11):2525-45, 2014
- el Barzouhi A et al: Magnetic resonance imaging in follow-up assessment of sciatica. N Engl J Med. 368(11):999-1007, 2013
- Watters WC 3rd et al: An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy. Spine J. 9(3):240-57, 2009
- van den Hout WB et al: Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation: cost utility analysis alongside a randomised controlled trial. BMJ. 336(7657):1351-4, 2008
- Weinstein JN et al: Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 33(25):2789-800, 2008
- Dammers R et al: Lumbar disc herniation: level increases with age. Surg Neurol. 58(3-4):209-12; discussion 212-3, 2002
- Fardon DF et al: Nomenclature and classification of lumbar disc pathology. Recommendations of the Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine (Phila Pa 1976). 26(5):E93-113, 2001
- Ito T et al: Types of lumbar herniated disc and clinical course. Spine. 26(6):648-51, 2001
- Carragee EJ et al: Provocative discography in patients after limited lumbar discectomy: a controlled, randomized study of pain response in symptomatic and asymptomatic subjects. Spine. 25(23):3065-71, 2000
- Kawaguchi Y et al: Association between an aggrecan gene polymorphism and lumbar disc degeneration. Spine. 24(23):2456-60, 1999
- Videman T et al: Magnetic resonance imaging findings and their relationships in the thoracic and lumbar spine. Insights into the etiopathogenesis of spinal degeneration. Spine. 20(8):928-35, 1995
- Weber H: The natural history of disc herniation and the influence of intervention. Spine. 19(19):2234-8; discussion 2233, 1994
- Brock M et al: The form and structure of the extruded disc. Spine. 17(12):1457-61, 1992
- Muralikuttan KP et al: A prospective randomized trial of chemonucleolysis and conventional disc surgery in single level lumbar disc herniation. Spine. 17(4):381-7, 1992
- Hashimoto K et al: Magnetic resonance imaging of lumbar disc herniation. Comparison with myelography. Spine. 15(11):1166-9, 1990
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
TERMINOLOGY
Synonyms
- Nonstandard: Herniated nucleus pulposus, slipped or prolapsed disc
Definitions
- Localized (< 25% of disc circumference) displacement of disc material beyond confines of disc space
- Protrusion
- Herniated disc with broad base at parent disc
- Greatest dimension of disc herniation in any plane ≤ distance between edges of base in same plane
- Herniated disc with broad base at parent disc
- Extrusion
- Herniated disc with narrow base or no base at parent disc
- Greatest dimension of disc herniation in any plane > distance between edges of base in same plane
- Herniated disc with narrow base or no base at parent disc
- Sequestered: Free fragment
- Extruded disc without continuity to parent disc
- Migrated
- Disc material displaced away from site of herniation
- Regardless of continuity
- Intravertebral herniation: Schmorl node (endplate herniation)
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Nonvascular Interventions
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
- Carlson BB et al: Lumbar disc herniation: what has the Spine Patient Outcomes Research Trial taught us? Int Orthop. 43(4):853-9, 2019
- Clark R et al: Surgical management of lumbar radiculopathy: a systematic review. J Gen Intern Med. 35(3):855-64, 2019
- Marcia S et al: Image-guided percutaneous treatment of lumbar stenosis and disc degeneration. Neuroimaging Clin N Am. 29(4):563-80, 2019
- El Barzouhi A et al: Reliability of gadolinium-enhanced magnetic resonance imaging findings and their correlation with clinical outcome in patients with sciatica. Spine J. 14(11):2598-60, 2014
- Fardon DF et al: Lumbar disc nomenclature: version 2.0. spine J. 14(11):2525-45, 2014
- el Barzouhi A et al: Magnetic resonance imaging in follow-up assessment of sciatica. N Engl J Med. 368(11):999-1007, 2013
- Watters WC 3rd et al: An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy. Spine J. 9(3):240-57, 2009
- van den Hout WB et al: Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation: cost utility analysis alongside a randomised controlled trial. BMJ. 336(7657):1351-4, 2008
- Weinstein JN et al: Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 33(25):2789-800, 2008
- Dammers R et al: Lumbar disc herniation: level increases with age. Surg Neurol. 58(3-4):209-12; discussion 212-3, 2002
- Fardon DF et al: Nomenclature and classification of lumbar disc pathology. Recommendations of the Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine (Phila Pa 1976). 26(5):E93-113, 2001
- Ito T et al: Types of lumbar herniated disc and clinical course. Spine. 26(6):648-51, 2001
- Carragee EJ et al: Provocative discography in patients after limited lumbar discectomy: a controlled, randomized study of pain response in symptomatic and asymptomatic subjects. Spine. 25(23):3065-71, 2000
- Kawaguchi Y et al: Association between an aggrecan gene polymorphism and lumbar disc degeneration. Spine. 24(23):2456-60, 1999
- Videman T et al: Magnetic resonance imaging findings and their relationships in the thoracic and lumbar spine. Insights into the etiopathogenesis of spinal degeneration. Spine. 20(8):928-35, 1995
- Weber H: The natural history of disc herniation and the influence of intervention. Spine. 19(19):2234-8; discussion 2233, 1994
- Brock M et al: The form and structure of the extruded disc. Spine. 17(12):1457-61, 1992
- Muralikuttan KP et al: A prospective randomized trial of chemonucleolysis and conventional disc surgery in single level lumbar disc herniation. Spine. 17(4):381-7, 1992
- Hashimoto K et al: Magnetic resonance imaging of lumbar disc herniation. Comparison with myelography. Spine. 15(11):1166-9, 1990
