What Is Discography?

Lumbar discography is an invasive diagnostic procedure that involves, instillation of iodinated contrast into the nucleus pulposus after inserting a needle under fluoroscopy. This procedure is done with an aim to get information on the morphology and integrity nucleus pulposus, vertebral endplates and anulus fibrosus.

In addition to this, the measured contrast injection allows determination of intradiscal pressures and response of the patient to this stimulation is a measure of pain caused by disc.

Thus discography not only to defines the anatomical architecture of the disc but also tells whether a particular disc is painful.

Basis Of Discography

Changes in the intervertebral disc and  anulus  are  potential sources of low-back pain. Pain  caused by internal disruption of the normal structural and biochemical integrity of the symptomatic disc is  called discogenic pain. Discography is done to establish and confirm discgenic pain. Read more

What Is Chemonucleolysis?

Chemonucleolysis is the term used to denote chemical destruction of nucleus pulposus [Cehmo+nucleo+lysis]. This involves intradiscal injection of chymopapain which causes hydrolysis of he cementing protein of the nucleus pulposus. This causes decrease in water binding capacity leading to reduction in size and drying the disc.

Chemonucleolysis is one of the methods to treat disc herniation not responding to conservative therapy.

Basis of Treatment

Nucleus Pulposus is soft, gelatinous material in the center of disc and is surrounded by a tough fibrous coating annulus fibrosus. In disc herniation weakened or torn annulus fibrosus allows nucleus pulposus to ooze out

Chemonucleolysis uses chymopapain, an enzyme derived from papyrus, to dissolve the disk material. Chemonucleolysis is appropriate for only some cases of HNP.

Chemonucleolysis is not effective in sequestered discs. In a sequestered disk, a fragment of the nucleus pulposus breaks loose from the disk and is free in the spinal canal. Read more

What Is Piriformis Syndrome?

Piriformis syndrome is one of the important causes of sciatica.  In this neuromuscular disorder, the sciatic nerve is compressed or  irritated by the piriformis muscle.

The symptoms are pain, tingling and numbness in the buttocks and along the path of the sciatic nerve descending down the lower thigh and into the leg.

The syndrome may occur due to anatomical variations in the muscle-nerve relationship, or from overuse or strain.

Piriformis syndrome should be considered as a possible diagnosis when sciatica occurs without a clear spinal cause. Read more

What Is Sciatica?

Sciatica is the term used to describe mild to intense pain in the lower limb. The term sciatica does not denote any disease. It is in fact a vague expression for a set of symptoms.

An equivalent medical  term is radiculopathy. It is  used to describe pain, numbness, tingling, and weakness in the arms or legs caused by a nerve root problem. If the nerve problem is in the neck, it is called a cervical radiculopathy. Since sciatica affects the low back, it is called a lumbar radiculopathy.

The pain is almost always caused by compression/or irritation of  either nerve root(s) that form the sciatic nerve.

The pain can also occur due to compression of the sciatic nerve itself.

The area where the pain is felt can include back,  buttock, the leg and foot. Read more

What Is Lumbar Spondylosis

Lumbar spondylosis is a type of spondylosis that occurs in lumbar spine.  It describes bony overgrowths, also called (osteophytes), predominantly those at the anterior, lateral, and, less commonly, posterior aspects of the superior and inferior margins of vertebral bodies.

Likelihood of spondylosis increases with age and is considered an inevitable part of aging.

Lumbar spondylosis is the price of  upright posture we have.

Etiology

Lumbar spondylosis appears to be a nonspecific aging phenomenon. As yet there has been found no relation to lifestyle, height, weight, body mass, physical activity, cigarette and alcohol consumption. Read more

Cellular and Biochemical Changes of Lumbar Spondylosis

Lumbar degeneration or spondylosis is can be seen on the biochemical, cellular, and morphologic levels. The initial events of disc degeneration are related to many intrinsic and extrinsic factors, including cellular apoptosis or programmed cell death, mechanical disc injury, and genetic contributions.

The culprit event likely is related to compromise nutrient diffusion and disc hydration. Read more

Morphologic and Biomechanical Changes In Lumbar Spondylosis

Three clinical and biomechanical stages of spinal degeneration have been described

• Initial early changes with mild dysfunction but no instability
• Later degenerative instability
• Disk space collapse. Read more

Biology of the Intervertebral Disc

Chondrocytes and fibroblastic cells are tissue constituents in the anulus, nucleus, and end plates. All these are are within an extensive, intricate extracellular matrix (ECM).

These cells are responsible for homeostasis of the ECM, including matrix formation, maintenance, and remodeling. The nutrition to these cells is derived from diffusion across the hyaline cartilage and subcortical end plates. Read more

Lumbar Spine-Biomechanics of the Intervertebral Disc

Intervertebral disc is a structure that is present between two bodies of adjoining vertebrae. Each component of the intervertebral disc has a specific histologic composition and structure that is responsible for a specific function. The vertebral end plates that are in direct contact wiith disc, consist of cortical bone in the periphery, which in adolescence is referred to as the ring apophysis, and compressed cancellous bone in the central disk area, which covers nearly 70% of the disk. Read more

Lumbar Spine-Morphologic and Functional Anatomy

The lumbar spine is a unique bony and ligamentous structure. It can withstand excessive loads while simultaneously protecting neurologic function and providing flexibility and stability.
This intricate interplay between the different anatomic components of the lumbar spine provides efficient motion and function that enables us so much mobility.

The five vertebral bodies and intervertebral disks of the lumbar spine withstand significant physiologic loads. The intervertebral segment of the lumbar spine consists of a three-articulation complex, the disk-vertebral body and two posterior apophyseal (facet) joints, to resist these high loads and stresses.

The vertebral bodies are a cylindrical mass of cancellous bone with a cortical shell. In between are the discs consisting of the anulus fibrosus, the nucleus pulposus, and the cartilaginous and bony end plates of the vertebral bodies.

The vertebral bodies and discs from the anterior column of the spine, which is responsible for resisting approximately 80% of axial compressive loads and maintaining spinal rigidity and alignment.

The intervertebral disc maintains separation of the vertebral bodies. Read more