Why we have Disk Herniations

Why we have Disk Herniations

Why we have Disk Herniations

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Today,  I saw a very rare patient.  Why?  Because he is 40 years old,  and his MRI report read “Normal Lumbar Spine.”   After looking at his MRI,  I came to the same conclusion.  There was no evidence of any disk narrowing,  disk dehydration, or bone spur development.  But he had back pain,  from a pulled muscle.  He probably did not need the MRI to diagnose that,  but that topic is another blog.

In the above picture of a Spine Model,  you can see that there is an entity called the Disk.  The disk is made up of two general parts.

1. The Annulus,  which is the tough outside cartilage wall,  that acts similar to a ligament  (a tissue connecting two bones to one another).  In the most simple of explanations,  it holds the vertebral bones in alignment.

2. The Nucleus,  which is the softer,  initially gelatinous center of the disk,  that gives the disk its shock absorbing properties.  Some will say it is like a very hard,  tough water balloon.  A tough outer skin,  but a watery soft inside that allows it to absorb some stress.

The problem is the disk does not maintain its water content forever.  Inside the Nucleus are special materials called proteoglycans.  At the earlier stages of life,  the proteoglycans absorb water very well,  thus maintaining the water pressure,  and height of the disk.  Scientists have discovered that as we age,  the proteoglycans change,  and cannot absorb as much water.  The water starts to leave the Nucleus.  Our water balloon starts to lose its firmness,  or turgor because of the loss of water content.  The disk height begins to shrink.   With the loss of turgor,  or strength,  there is more motion or slack in the disk.  This allows the vertebral bones to shift more.  This causes stresses to the ligaments,  muscles and tendons surrounding the disk.  It will also cause extra motion of the joints of the spine called facet joints.  With the extra motion,  the smooth cartilage lining starts to wear,  and you start to develop spine arthritis in the joints.  In addition,  the slack in the disk  allows extra motion and stress on the wall of the disk,  potentially causing fissures in the annulus.  Also,  with the extra motion,  the insertions of the disk on the endplates of the vertebra can weaken causing micro fractures of the endplates.  The latest research show that this endplate failure may very well be the real reason disks herniate.  As the endplate gives way,  the softer Nucleus penetrates out along with the endplate.

Of course,  we are over simplifying this topic.  Compound this degeneration with some sort of stress,  and now we may have a  Herniated Nucleus Pulposus or a Herniated Disk.   Incidently,  the concept of degeneration predisposing people to herniations is considered common sense,  but the research has not  yet confirmed this seemingly obvious conclusion.  Nevertheless,  this degeneration process is thought to explain the identification of Disk Herniations in the majority of people over the age of 40.

In the first part of the Blog,  I commented on the rarity of a normal Lumbar MRI in a 40 year old.  I hope the reader now understands why I made that statement.

Citations

  • Von Forell GA, Stephens TK, Samartzis D, Bowden AE. Low Back Pain: A Biomechanical Rationale Based on "Patterns" of Disc Degeneration. Spine (Phila Pa 1976). 2015 Aug 1;40(15):1165-72. PubMed PMID: 25996532

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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