Lumbar (Intervertebral) Disk Disorders
- Author: Jere F Baldwin, MD; Chief Editor: Rick Kulkarni, MD more...
Background
Lumbar disk disease is a frequent source of low back pain. Sciatica is defined as neuralgia along the course of the sciatic nerve.
Pathophysiology
The intervertebral disks act as shock absorbers and are found between the bodies of the vertebrae. They have a central area composed of a colloidal gel, called the nucleus pulposus, which is surrounded by a fibrous capsule, the annulus fibrosis. This structure is held together by the anterior longitudinal ligament, which is anterior to the vertebral bodies, and the posterior longitudinal ligament, which is posterior to the vertebral bodies and anterior to the spinal cord. The muscles of the trunk provide additional support.
The most common site of disk herniation is at the L5-S1 interspace in the lumbosacral region. This is believed to be due to the thinning of the posterior longitudinal ligament as it extends caudally.
Nomenclature specific to lumbar disk disease is as follows:
- Disk bulge - Annular fibers intact
- Disk protrusion - Localized bulging with damage of some annular fibers
- Disk extrusion - Extended bulge with loss of annular fibers, but disk remains intact
- Disk sequestration - Fragment of disk broken off from the nucleus pulposus
Epidemiology
Frequency
United States
Sciatica has been reported by various authors to occur in 1-10% of the population.
Mortality/Morbidity
Low back pain usually is self-limited and of short duration.
Sex
The male-to-female ratio is approximately 1:1.
Age
The group most commonly affected is adults aged 25-45 years.
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