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KEYWORDS:
Intervertebral disc; Anatomy and histology; Physiopathology; Blood supply; Innervation; Herniated disc
Intervertebral discs play a significant role in the support, durability, and flexibility of the spine. While discs allow for some movement between different spinal segments, they provide tremendous stability of the overall spinal column in the face of a variety of different forces and massive loads. Disc degeneration is a relatively common problem, and its incidence seems to increase with the aging process. Changes consistent with disc degeneration have been identified in teens.1 It has been shown that approximately 20% of teenage discs are already showing signs of disc degeneration and they are nearly universal by the eighth decade.2 Although the correlation between disc degeneration and disc-related pain is not precise, there is a known strong association between them.3,4 The prevalence rates in the UK have ranged from as low as 12% to as high as 35%, depending on inclusion criteria. Of those patients, about 10% develop chronic pain with disability.5 As the population of the US continues to age, the incidence and prevalence of pain related to disc degeneration will undoubtedly increase and with it the economic burden on the society. Fundamental to an appropriate treatment strategy is a thorough comprehension of the disc anatomy as well as the pathophysiology and its clinical presentation.
Gross anatomy
There are a total of 23 discs in the entire length of the spinal cord. When the height of all the discs (approximately 8-10 mm in height and 4 cm in diameter) are considered, they
Address reprint requests and correspondence: Hariharan Shankar, MBBS, Department of Anesthesiology, Clement Zablocki VA Medical
Center, 5000 West National Avenue, Milwaukee, WI 53295. E-mail address: hshankar@mcw.edu. 1084-208X/$ -see front matter Published by Elsevier Inc. doi:10.1053/j.trap.2009.05.001 Techniques in Regional Anesthesia and Pain Management (2009) 13, 67-75