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Lumbar Intervertebral Disc Herniation
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Nonstandard: Herniated nucleus pulposus
            • Nonstandard: "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
            • 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
            • 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

                                        1. 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. ePub, 2014
                                        2. Fardon DF et al: Lumbar Disc Nomenclature: Version 2.0. Spine J. ePub, 2014
                                        3. el Barzouhi A et al: Magnetic resonance imaging in follow-up assessment of sciatica. N Engl J Med. 368(11):999-1007, 2013
                                        4. 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
                                        5. 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
                                        6. 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
                                        7. Dammers R et al: Lumbar disc herniation: level increases with age. Surg Neurol. 58(3-4):209-12; discussion 212-3, 2002
                                        8. 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-E113, 2001
                                        9. Ito T et al: Types of lumbar herniated disc and clinical course. Spine. 26(6):648-51, 2001
                                        10. 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
                                        11. Kawaguchi Y et al: Association between an aggrecan gene polymorphism and lumbar disc degeneration. Spine. 24(23):2456-60, 1999
                                        12. 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
                                        13. Weber H: The natural history of disc herniation and the influence of intervention. Spine. 19(19):2234-8; discussion 2233, 1994
                                        14. Brock M et al: The form and structure of the extruded disc. Spine. 17(12):1457-61, 1992
                                        15. 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
                                        16. 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
                                                  • Nonstandard: "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
                                                  • 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
                                                  • 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

                                                                              1. 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. ePub, 2014
                                                                              2. Fardon DF et al: Lumbar Disc Nomenclature: Version 2.0. Spine J. ePub, 2014
                                                                              3. el Barzouhi A et al: Magnetic resonance imaging in follow-up assessment of sciatica. N Engl J Med. 368(11):999-1007, 2013
                                                                              4. 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
                                                                              5. 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
                                                                              6. 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
                                                                              7. Dammers R et al: Lumbar disc herniation: level increases with age. Surg Neurol. 58(3-4):209-12; discussion 212-3, 2002
                                                                              8. 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-E113, 2001
                                                                              9. Ito T et al: Types of lumbar herniated disc and clinical course. Spine. 26(6):648-51, 2001
                                                                              10. 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
                                                                              11. Kawaguchi Y et al: Association between an aggrecan gene polymorphism and lumbar disc degeneration. Spine. 24(23):2456-60, 1999
                                                                              12. 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
                                                                              13. Weber H: The natural history of disc herniation and the influence of intervention. Spine. 19(19):2234-8; discussion 2233, 1994
                                                                              14. Brock M et al: The form and structure of the extruded disc. Spine. 17(12):1457-61, 1992
                                                                              15. 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
                                                                              16. Hashimoto K et al: Magnetic resonance imaging of lumbar disc herniation. Comparison with myelography. Spine. 15(11):1166-9, 1990