Internal disc disruption
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Search Strategy[edit | edit source]
PubMed:
• Internal disc disruption
Web of knowledge:
• Internal disc disruption
No language restrictions were made, but only English articles have been used.
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• Internal disc disruption
Definition/Description[edit | edit source]
It is assumed that Internal Disc Disruption (IDD) is an important cause of low back pain[1]. Crock[2] defined that the affected disc in IDD is rendered painful by changes in its internal structure, while its external appearance remains normal. In particular he reported annular fissures that distort the internal architecture of the disc while the disc externally appears intact and undeformed. This forms the major difference between IDD and disc herniation, which shows a true disruption of the external structure. IDD is not the same as disc degeneration. It’s a condition in which you can speak of a degeneration of the matrix of the nucleus pulposus with radial fissures that penetrate the annulus fibrosus but do not reach the outer lamella[3].
IDD of the lumbar intervertebral disc is often overlooked as possible diagnosis in chronic low back pain.
Clinically Relevant Anatomy[edit | edit source]
Click on the link for more specific details about intervertebral disc.
Epidemiology /Etiology[edit | edit source]
Chronic low back pain is the major cause of work-related disability in people under age 45. Only a few of these patients (< 15%) has a discus herniation, which compromise a nerve-root. The majority of this population (85%) suffers from non-neurological back pain and a significant proportion of these patients are assumed to be related to musculoligamentous injury or degenerative changes. Internal disc disruption is a common entity.
30% to 50% of people with chronic low back pain become an IDD diagnosis. In principle, any structure in the spine can be a possible source of pain because it is innervated (rich innervation of the outer third of the annulus fibrosus, extended nerve fibers in the middle third of the annulus[1])[4].
Characteristics/Clinical Presentation[edit | edit source]
Most patients experience:
- Diffuse, dull ache
- Deep-seated, burning, lancinating pain in the back
- Movements in the lumbar s pine are slow
- Movements in the lumbar spine are guarded and restricted
Some patients experience:
- Sensation of weak, unstable back
- Referral pain in hips and lower limbs (not uncommon)
Acute cases:
Earlier lifting movements with trauma are the cause of the back pain[5].
Further on, lumbar fusion is de second most common cause of low back pain .
Chronic stage:
Pain and muscle spasm are less striking and dramatic
In general: nondescript pain and a negative physical examination in a severely apprehensive patient is the most common clinical scenario.
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References[edit | edit source]
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- ↑ 1.0 1.1 Schwarzer A.C., Aprill C.N., Derby R. et al. The prevalence and clinical features of internal disc disruption in patients with chronic low back pain. Spine 1195;20:1878-1883. Level of evidence: B
- ↑ Crock H.V. Internal disc disruption. A challenge to disc prolapse fifty years on. Spine 1986; 22:650-3 Level of evidence: C
- ↑ DePalma M.J. iSpine – Evidence-Based Interventional Spine Care. New York: Demos Medical Publishing: 2011. Level of evidence: D
- ↑ DePalma M.J., Ketchum J.., Saullo T. What Is the Source of Chronic Low Back Pain and Does Age Play a Role? Pain Medicine 2011; 12: 224–233 Leve of evidence: B
- ↑ DePalma M.J., Ketchum J.M., Saullo T.R. Etiology of Chronic Low Back Pain in Patients Having Undergone Lumbar Fusion. Pain Medicine 2011 APR 11; 12(5): 732-739. Level of evidence: B
