PRESENTED BY

GERMAINE OCA, PTRP

A central nucleus pulposus Surrounded by peripheral annulus fibrosus Two layers of cartilage which cover top and bottom aspect of each disc called a vertebral end plate Its separate the disc from the adjacent vertebral body .

It is semi fluid mass of mucoid material seems like a tooth paste It consist of few cartilage cells and irregular arranged collagen fibers The fluid nature of nucleus pulposus allowed it to be deformed under pressure The nucleus attempt to deformed and will there by transmit the applied pressure in all direction .

They are thick in anterior and lateral portion of the annulus but posteriorly they are finer and more tightly packed. The collagen fibers are arranged in between 10 to 20 sheets called lamellae.The annulus fibrosus consist of collagen fibers. The collagen fibers lie parellel to each other. These are arranged in concentric rings that surround the nucleus pulposus. .

6-1 mm thick.Each vertebral end plate is a layer of cartiladge about 0. Nucleus pulposus is entirely covered but annulus fibrosus is only 66% covered by the end plates. . Covers the area on the vertebral area encircled by the ring apophysis.

The term prolapsed disc means the protrusion or extrusion of the nucleus pulposus through a rent in the annulus fibrosus. It has a four stages Bulging Protrusion Extrusion sequestration .

Heavy manual labour Repetitive lifting and twisting Postural stress Monotonous work Lack of personal control on work Poor physical fitness Poor and inadequate strength of the trunk Smoking Aging process Mechanical breakdown & loss of nutritional pathways .

It only occurs if the disc has deteriorated as a result of repeated microtraumas and if the annulus fibres have started to degenerate Disc prolapse usually follows lifting of weight with the trunk flexed forward. Disc prolapse occurs in three stages .

First stage Trunk flexion flattens the disc anteriorly and open out the intervertebral space posteriorly Second stage As soon as the weight is lifted the increased axial compression force crushes the whole disc and violently drives the nuclear substance posteriorly until it reaches the deep surface of PLL. .

Third stage With the trunk nearly straight . . the path taken by the herniating mass is the closed by the pressure of vertebral plateaus and the hernia remains trapped under the posterior longitudinal ligament.

Prolapse occurs in two manners also   Sudden disc prolapse Gradual disc prolapse .

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Degenerative changes occur disc before displacement of the nuclear material. These changes are :o Softening of the nucleus and its fragmentation o Weakening and the disintegration of the posterior part of the annulus .

either because a small area of entire thickness has disintegrated spontaneously or because of injury. The nucleus tends to bulge out. .The nucleus is under positive pressure at all times When the annulus becomes weak.

This is the stage of repair. The extruded nucleus pulposus becomes flattened.fibrosed and finally undergoes calcification. the residual nucleus pulposus become fibrosed. . This begins alongside of degeneration.

Three types of annulus tears Concentric(circumferential) tears Tears between adjacent lamellae Rim lesions Focal circumferential avulsion of peripheral annulus Radial fissure Allows nucleus material to escape .

Some of the inner disc fibres could be torn and the soft jelly (nucleus pulposus) is spiling outwards into the disc fibres but not out of the disc . It retains a slight bulge at one side of the disc.Bulging At this early stage. the disc is stretched and doesn·t completely return to its normal shape when pressure is relieved.

. barely held in by the remaining disc fibres.Protrusion At this stage. the bulge is very prominent and the soft jelly centre has spilled out to the inner edge of the outer fibres.

Extrusion In the case of a herniated spinal disc. the soft jelly has completely spilled out of the disc and now protruding out of the disc fibres. .

Sequestration Here some of the jelly material is breaking off away from the disc into the surrounding area .

CLINICAL ANATOMY OF LUMBAR SPINE ² BOGDUK KINESIOLOGY OF THE JOINTS ² KAPANDJI CLINICAL ORTHOPAEDIC REHAB ² BROTZMAN ESSENTIAL ORTHOPAEDICS .MAHESWARI .

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