THE IV DISC CONSISTS OF THREE DISTINCT
1.THE CARTILAGE END PLATES
THE CARTILAGE RING ARE THIN LAYERS OF
HYALINE CARTILAGE BETWEEN TWO
ADJACENT VETEBRAL BODIES AND DISC
IT IS SEQUENCE OF CHANGES OCURRING IN THE DISC WHICH LEAD TO
PROTRUSION OR EXTRUSION OF NP THROUGH A RENT IN THE AF.
THESE CHANGES CONSISTS OF THE FOLLOWING :
A) NUCLEUS DEGENERATION : degenerative changes occur in the disc
before displacement of the nuclear material. these changes are:
(i) Softening of the nucleus and its fragmentation
(ii) Weakening and disintegration of the posterior part of the annulus
B) NUCLEUS DISPLACEMENT : the nucleus is under positive pressure
at all the times. When annulus become weak ,either because a small area of
its entire thickness has been disintegrated spontaneously or because of the
injury , the nucleus tends to bilge through the defect. This is known as disc
This tendency is greatly increased if the nucleus is degenerated and
fragmented. Finally the nucleus comes out of the annulus , and the under the
post” longitudinal ligament though it has not lost contact between with
parent disc. This is called as disc extrusion.
Once the disc is extruded it cannot go back and PLL is not strong enough to
prevent the nucleus protruding further. So, the extruded disc, may loose its
contact with parent disc. The sequestrated disc may come to lie behind the
PLL or may become free fragments in the canal.
C) STAGE OF FIBROSIS : this the stage of repair.
the begins alongside of degeneration . The residual
nucleus pulposus becomes flattened , fibrosed , and
finally undergoes calcification. At the same time, new
bone formation occurs at the point where the PLL has
been stripped from the vertebral body and
•POSTURE (rigid posture , loss of curve spine( i.e flattened back
in lumbar spine , posterior pelvic tilt , sciatic scoliosis may present
•MOVEMENT : trunk flexion (may be painful , flexion may produce
•TENDERNESS : along midline or lateral to spinous processes.
IN CASE OF Cx PIVD :
a) Foraminal compression / spurling test
b) Distraction test
c) ULTT(upper limb tension test)
d) Shoulder abduction test
e) Tinel’s sign