• Normal intervertebral disc contains central nucleus pulposus (water, proteoglycans) within an annulus of obliquely oriented collagen fibers and a cartilaginous end plate
• Elderly have shrunken, yellowed and dehydrated nucleus pulposus
• Common surgical specimen, obtained after intervertebral disc prolapse or herniation, which is most common in ages 20-39 years
• Anterior herniation usually is asymptomatic; posterior herniation puts pressure on nerve roots or spinal canal and produces symptoms
• Posterior herniation present in 50% of older individuals at autopsy, usually in lumbar spine
• Herniation refers to either prolapse, protrusion or extrusion
  
  
• Protrusion:
  • Bulging of nucleus pulposus through weakened annulus fibrosus, usually posterior or posteriolateral
  • Can rarely disappear spontaneously
• Prolapse:
  • Rupture of nucleus pulposus through annulus but not the posterior or anterior longitudinal ligament
  • Associated with neovascularization at edges of fibrocartilaginous fragments (Hum Pathol 1988;19:406)
  • Usually in lumbar region
  • May occur in thoracic or cervical disc
• Extrusion: rupture of nucleus pulposus through annulus and posterior or anterior longitudinal ligament
• Sequestration:
  • Fragmentation of extruded segment, may extend into spinal canal or far from site of rupture
  • Clinical symptoms depend on severity of herniation and position of offending disc
  • Patient may develop Cauda equine syndrome in severe cases

• 45 year old woman with low back ache and sciatica (Br J Gen Pract 2008;58:646)

• 52 year old woman with abdominal pain (Ann R Coll Surg Engl 2009;91:W4)
• 60 year old man with brucellosis masquerading as spondylodiscitis with multiple intervertebral disc prolapse (J Glob Infect Dis 2012;4:184)

• 53 year old woman with spontaneous regression of large lumbar disc extrusion. (J Korean Neurosurg Soc 2010;48:285)
• 68 year old man with extrusion of C7-D1 intervertebral disc associated with intradiscal hematoma (Turk Neurosurg 2011;21:446)

• 49 year old man with sequestered L5-S1 disc (Cox® Technic Case Report #63 sent August 2008 (pdf))

• Annular fibrosus: collagen (pink)
• Nucleus pulposus: pure cartilage (blue)
• Herniated disk: vascular ingrowth
• Also chondrocyte proliferation, structural alterations in form of tears and clefts, granular changes and mucous degeneration (BMC Res Notes 2011;4:497)

Intervertebral disc

Disc degeneration

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