| Intervertebral disc |
|
Intervertebral disc
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| Details |
| Latin |
Disci intervertebrales |
| Identifiers |
| Gray's |
p.289 |
| MeSH |
A02.165.308.410 |
Dorlands
/Elsevier |
12300697 |
| TA |
A03.2.02.003 |
| FMA |
10446 |
| Anatomical terminology |
An intervertebral disc (or intervertebral fibrocartilage) lies between adjacent vertebrae in the vertebral column. Each disc forms a fibrocartilaginous joint (a symphysis), to allow slight movement of the vertebrae, and acts as a ligament to hold the vertebrae together. Their role as shock absorbers in the spine is crucial.
Contents
- 1 Structure
- 2 Function
- 3 Clinical significance
- 3.1 Herniation
- 3.2 Degeneration
- 3.3 Scoliosis
- 3.4 Intervertebral disc space
- 3.5 Spelling note
- 4 See also
- 5 Additional images
- 6 References
- 7 External links
Structure
Cervical vertebra with intervertebral disc
Discs consist of an outer fibrous ring, the anulus fibrosus disci intervertebralis, which surrounds an inner gel-like center, the nucleus pulposus. The anulus fibrosus consists of several layers (laminae) of fibrocartilage made up of both type I and type II collagen. Type I is concentrated towards the edge of the ring where it provides greater strength. The stiff laminae can withstand compressive forces. The fibrous intervertebral disc contains the nucleus pulposus and this helps to distribute pressure evenly across the disc. This prevents the development of stress concentrations which could cause damage to the underlying vertebrae or to their endplates. The nucleus pulposus contains loose fibers suspended in a mucoprotein gel. The nucleus of the disc acts as a shock absorber, absorbing the impact of the body's activities and keeping the two vertebrae separated. It is the remnant of the notochord.[1]
There is one disc between each pair of vertebrae, except for the first cervical segment, the atlas. The atlas is a ring around the roughly cone-shaped extension of the axis (second cervical segment). The axis acts as a post around which the atlas can rotate, allowing the neck to swivel. There are 23 discs in the human spine: 6 in the neck (cervical region), 12 in the middle back (thoracic region), and 5 in the lower back (lumbar region). For example, the disc between the fifth and sixth cervical vertebrae is designated "C5-6".
Development
During development and at birth, vertebral discs have some vascular supply to the cartilage endplates and the annulus fibrosus. These quickly deteriorate leaving almost no direct blood supply in healthy adults.[2]
Function
The intervertebral disc functions to separate the vertebrae from each other and provides the surface for the shock-absorbing gel of the nucleus pulposus. The nucleus pulposus of the disc functions to distribute hydraulic pressure in all directions within each intervertebral disc under compressive loads. The nucleus pulposus consists of large vacuolated notochord cells, small chondrocyte-like cells, collagen fibrils, and aggrecan, a proteoglycan that aggregates by binding to hyaluronan. Attached to each aggrecan molecule are glycosaminoglycan (GAG) chains of chondroitin sulfate and keratan sulfate.[3] Aggrecan is highly negatively charged, allowing the nucleus pulposus to swell by imbibing water. The amount of glycosaminoglycans (and hence water) decreases with age and degeneration.[4]
Clinical significance
Main article: Intervertebral disc disorder
Stages of spinal disc herniation
Herniation
A spinal disc herniation commonly called a slipped disc, can happen when the gel-like material of the nucleus pulposus is forced against a weakness in the surrounding anulus fibrosus, putting pressure on the nearby nerve. This can give the symptoms of sciatica if it impinges on the roots of the sciatic nerve. The disc is not physically slipped; it bulges, usually in just one direction.
Degeneration
Before age 40 approximately 25% of people show evidence of disc degeneration at one or more levels. Beyond age 40, more than 60% of people show evidence of disc degeneration at one or more levels on magnetic resonance imaging (MRI).[5]
One effect of ageing and disc degeneration is that the nucleus pulposus begins to dehydrate and the concentration of proteoglycans in the matrix decreases, thus limiting the ability of the disc to absorb shock. This general shrinking of disc size is partially responsible for the common decrease in height as humans age. The anulus fibrosus also becomes weaker with age and has an increased risk of tearing. In addition, the cartilage endplates begin thinning, fissures begin to form, and there is sclerosis of the subchondral bone.[2]
Scoliosis
Main article: Scoliosis
While this may not cause pain in some people, in others it may cause chronic pain. Other spinal disorders can affect the morphology of intervertebral discs. For example, patients with scoliosis commonly have calcium deposits (ectopic calcification) in the cartilage endplate and sometimes in the disc itself.[6] Herniated discs are also found to have a higher degree of cellular senescence than non-herniated discs.[2]
Intervertebral disc space
The intervertebral disc space is typically defined on an X-ray photograph as the space between adjacent vertebrae. In healthy patients, this corresponds to the size of the intervertebral disc. The size of the space can be altered in pathological conditions such as discitis (infection of the intervertebral disc).
Spelling note
Historically the word anulus was written (mistakenly) as annulus but has now been in use as anulus since it is derived from the Latin anus meaning ring.[7]
See also
This article uses anatomical terminology; for an overview, see anatomical terminology.
- Back pain
- Lumbar spinal stenosis
- Disc decompression traction procedure
Additional images
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Artificial intervertebral disc
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Posterior longitudinal ligament, in the thoracic region.
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Median sagittal section through the occipital bone and first three cervical vertebrae.
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Costovertebral articulations. Anterior view.
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Lumbar and sacral plexus. Deep dissection. Anterior view
-
Lumbar and sacral plexus. Deep dissection. Anterior view
References
- ^ McCann, Matthew; Owen J. Tamplin; Janet Rossant; Cheryle A. Séguin (25 October 2011). "Tracing notochord-derived cells using a Noto-cre mouse: implications for intervertebral disc development". Disease Models & Mechanisms. doi:10.1242/dmm.008128.
- ^ a b c Roberts S, Evans H, Trivedi J, Menage J (April 2006). "Histology and pathology of the human intervertebral disc". J Bone Joint Surg Am 88 (Suppl 2): 10–4. doi:10.2106/JBJS.F.00019. PMID 16595436.
- ^ See Figure 1 in US patent application 2007/0003525.
- ^ Antoniou, J.; Steffen, T.; Nelson, F.; Winterbottom, N.; Hollander, A. P.; Poole, R. A.; Aebi, M.; Alini, M. (1996). "The human lumbar intervertebral disc: Evidence for changes in the biosynthesis and denaturation of the extracellular matrix with growth, maturation, ageing, and degeneration". Journal of Clinical Investigation 98 (4): 996–1003. doi:10.1172/JCI118884. PMC 507515. PMID 8770872.
- ^ "Intervertebral Disc Disorders". MDGuidelines. Reed Group. 1 December 2012.
- ^ Giachelli CM (March 1999). "Ectopic calcification: gathering hard facts about soft tissue mineralization". Am. J. Pathol. 154 (3): 671–5. doi:10.1016/S0002-9440(10)65313-8. PMC 1866412. PMID 10079244.
- ^ Federative Committee on Anatomical Terminology (FCAT) (1998). Terminologia Anatomica. Stuttgart: Thieme
External links
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Wikimedia Commons has media related to Intervertebral discs. |
- Intervertebral Discs
- Spinal Disc Summary
- Cross section image: pembody/body12a - Plastination Laboratory at the Medical University of Vienna
- From Occiput to Coccyx
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Joints and ligaments of torso
|
|
| Vertebral |
| Syndesmosis |
| Of vertebral bodies |
- anterior longitudinal ligament
- posterior longitudinal ligament
|
|
| Of vertebral arches |
- ligamenta flava
- supraspinous ligament
- interspinous ligament
- intertransverse ligament
|
|
|
| Symphysis |
- intervertebral disc (anulus fibrosus
- nucleus pulposus)
|
|
| Synovial joint |
| Atlanto-axial |
- Medial: Cruciate ligament of atlas (Transverse ligament of atlas)
- Alar ligament
- Apical ligament of dens
- Tectorial membrane of atlanto-axial joint
- anterior atlantoaxial ligament
- posterior atlantoaxial ligament
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| Zygapophysial |
|
|
| Lumbosacral |
|
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| Sacrococcygeal |
- anterior sacrococcygeal ligament
- posterior sacrococcygeal ligament
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|
|
|
| Thorax |
| Costovertebral |
| Head of rib |
- Radiate ligament
- Intra-articular ligament
|
|
| Costotransverse |
- Costotransverse ligament
- Lumbocostal ligament
|
|
|
| Sternocostal |
- interarticular sternocostal ligament
- radiate sternocostal ligaments
- costoxiphoid ligaments
|
|
| Interchondral |
|
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| Costochondral |
|
|
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| Pelvis |
| Syndesmoses of pelvic girdle |
- Obturator membrane
- Obturator canal
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|
| Pubic symphysis |
- superior pubic ligament
- inferior pubic ligament
|
|
| Sacroiliac |
- anterior sacroiliac ligament
- posterior sacroiliac ligament
- interosseous sacroiliac ligament
- ligaments connecting the sacrum and ischium: sacrotuberous ligament
- sacrospinous ligament
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Index of joint
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| Description |
- Anatomy
- head and neck
- cranial
- arms
- torso and pelvis
- legs
- bursae and sheathes
- Physiology
|
|
| Disease |
- Arthritis
- acquired
- back
- childhood
- soft tissue
- Congenital
- Injury
- Symptoms and signs
- Examination
|
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| Treatment |
- Procedures
- Drugs
- rheumatoid arthritis
- gout
- topical analgesics
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| Authority control |
- GND: 4143992-2
- NDL: 00573500
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