Latest on Why Discs Herniate

Latest on Why Discs Herniate

Latest on Why Discs Herniate

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The above image is taken from August 1, 2013 Spine.  It is the title of the ISSLS Prize winning article by Dr. Rajasekaran.  As you can see,  it was a prospective study microscopically analysing disk material retrieved from 181 subjects,  who underwent lumbar discectomy surgery.

Patients selected for surgery met the criteria of being younger than 60 years of age.  Patients also must have no evidence of bony canal stenosis,  or other spinal disorders.  Patients  must have had no prior surgery.  The average age was about 37 years old.   Finally,  patients must also have a normal body mass index.

All surgery was performed by one surgeon,  so there was no difference in surgical technique.  All surgeries were a single level lumbar microdiscectomy.  There was also 724 non operated disc herniations identified that served as controls.

Amazingly,  all of the disk (surgically treated, or non surgically treated)  had diagnostic testing including  plain x-rays,  MRI’s,  and thin slice CT scans at the level of the involved endplates.

Intra operatively,  each disk was carefully probed to see if there was an annular tear.  If a tear was present,  the disk material was retrieved from the tear. If there were no identified tear,  the annulus was carefully incised, so as not to disturb the endplates while the herniated material was removed.

Disk material was then visualized,  palpated,  and then sent for microscopic histologic evaluation.

 

Interesting Results:

Of the non-operated discs,  84 of 724 had CT evidence of Endplate Junction (EPJ) avulsion.  Interestingly,  104 of 181 operated discs had obvious CT evidence of EPJ.

High intensity zones were present in 25 of the 181 surgically treated discs.  High intensity zones were also present in 41 of the 724 non surgically treated discs.

Of the 18 surgically treated discs with a central HIZ lesion,  interestingly 14 of the surgically treated discs had herniations located posterolaterally,  and not centrally.

Of the surgically treated disc herniations,  70% had evidence of  endplate material present in the removed specimen.

Conclusion:  Endplate Junction failure is a more common cause of why discs herniate.  Because MRI’s are not as specific to bony changes,  MRI’s have missed this prevalent cause of disk herniations.

 

So,  where does this study lead us?  It appears the concept of a HIZ lesion indicating a annular disruption may not be true.  Discs likely herniate secondary to the failure of the endplate at the junction of the disc.  MRI’s may not identify endplate failures that are associated with disc herniations.  Like all research studies,  it leads to more questions,  while clarifying one question.

 

 

 

 

 

 

 

 

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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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