Glossary of disc pathology terms• Herniation: nonspecific term subject to misinterpretation. – Not recommended.• Bulge: diffuse enlargement of disc area – Very common – Usually not clinically important – May contribute to spinal stenosis• Protrusion: nucleus pulposis pushes focally through fibers of annulus fibrosis – Base wider than apex – May focally impinge on nerve or thecal sac
Glossary of disc pathology terms• Extrusion: nucleus material pushes out beyond posterior longitudinal ligament but remains in contact with disc space – Apex wider than base – Likely to impinge on nerve roots• Sequestration: Disc fragment isolated from parent disc
Take Home Points Regarding Prevalence• many imaging findings are common in asx’s• certain findings are related to prior low back pain and more likely to be clinically important –extrusions, root comp, stenosis
Rationale for Imaging• r/o low prob red flag condition• rule-in treatable conditions –stenosis –herniated disc –spondyloarthropathy ? –instability
Early Imaging Red Flags• ? Fx –h/o major trauma –minor trauma in older or osteoporotic pt
Red Flags• age>50 or <20• h/o malignancy• constitutional sx• ↑ infection risk (IVDA, HIV, etc)
Red Flags• possible cauda equina syndrome –saddle anesthesia –urinary retention –severe/progressive neurologic deficit in lower extremity
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