The intervertebral disc (IV disc) comprises three components: cartilage end plates, nucleus pulposus, and annulus fibrosus. Degenerative changes can lead to conditions such as disc protrusion and extrusion, where the nucleus can bulge or completely expel through the annulus, often due to factors like poor health, trauma, or biomechanical issues. Assessment and treatment involve evaluating posture, movement, and applying specific tests for cervical and lumbar herniated discs.

3. THE IV DISC CONSISTS OF THREE DISTINCT
COMPONENTS :
1.THE CARTILAGE END PLATES
2.NUCLEUS PULPOSUS
3.ANNULUS FIBROSUS.
THE CARTILAGE RING ARE THIN LAYERS OF
HYALINE CARTILAGE BETWEEN TWO
ADJACENT VETEBRAL BODIES AND DISC
PROPER.

10. Common site :
C5/C6
L4/L5
L5/S1

12. CONGENTIAL
DEVELOPMENT
AL
•POOR NUTRITION
•POOR HEALTH HABITS
•ACCUMATED TRAUMA : SPORTS,AUTOMOBILE INJURY
LEAD TO WEAKING OF I.V.DISC
•BIOMECHANICAL FACTORS
•POSTURE
•REPITITIVE MICROTRAUMA , FLEXION (COMPRESSION
INJURIES) , TENSIONAL INJURIES

15. 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

16. 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
protrusion.
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.

18. 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
spurformation occurs.

22. ASSESSMENT TREATMENT
ASSESSSMENT :
•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
pain .)
•TENDERNESS : along midline or lateral to spinous processes.

24. 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
(a)

25. (b)
(c)
(e)
(d)

26. IN CASE OF Lx PIVD:
a) SLR
b) Lasegue’s test
c) Bowstring test
d) Prone knee bending (PKB) test
e) Sensory impairment (over dermatomes motor
weakness over myotomal distraction)

27. (d) (e)

32. CONSERVATIVE OPERATIVE