You are on page 1of 2

Anatomy and pathophysiology of intervertebral disc disease

Hariharan Shankar, MBBS,a,b Jeremy A. Scarlett, MD,b Stephen E. Abram, MDb


From the aDepartment of Anesthesiology, Clement Zablocki VA Medical Center, Milwaukee, Wisconsin; and the bDepartment of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Intervertebral discs provide support and cushioning against mechanical loads. Changes secondary to aging and degeneration lead to loss of this important function. This also sets the stage in some for disc-related pain. Various therapeutic modalities have been attempted with minimal long-term success to alleviate the poorly described disc-related pain. To better understand the pain originating from the disc, this article attempts to explore the anatomy of the disc and the different perturbations that occur following aging and degeneration. There is a great deal of similarity among the discs in different levels. They all consist of a nucleus pulposus, surrounded by the annulus fibrosus, whose outer layers integrate with the endplate and the ligaments to strengthen and provide support. The spinal arteries provide the nutrient supply, and the lack thereof seems to be a hallmark of degeneration and aging. The nerve supply is provided by the sympathetic chain and from the recurrent sino vertebral nerve, but only the outermost layers of the annulus contain the sensory nerve fibers. There also appears to be some genetic variation in the rate and degree of synthesis and breakdown in the primary structural components of the disc, increasing the predisposition for disc-related pain. This review will also briefly discuss the evidence that has accumulated regarding the occurrence of such pathologic changes from a genetic and ergonomic perspective. Published by Elsevier Inc.

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

You might also like