Disc protrusions are a type of disc herniation characterised by protrusion of disc content beyond the normal confines of the intervertebral disc, over an segment less than 25% of the circumference of the disc. The width of the base is wider than the largest diameter of the disc material which projects beyond the normal disc margins. The protrusion must not extend above of below the relevant vertebral endplates 4.
A disc protrusion is also described in terms of its axial position, into central, subarticular, foraminal, extraforaminal or anterior locations 4.
Additionally the terms contained (outer annulus fibrosus laminae are intact) and non-contained (all laminae are deficient) are also sometimes used 4.
Disc bulge is distinguished form a disc protrusion in that it involves more than 25% of the circumference.
A disc extrusion is distinguished form a disc protrusion in that the base of protruded disc material base is narrower than its 'dome'. Further more this material may extend above or below the disc level.
Note: A number of definitions of what exactly constitutes a disc protrusion have been proposed over the years, and it is important to realise that these differ substantially from one another 1-4. At the time of writing (August 2016) the most recent and widely used terminology was proposed in 2014 by Fardon et al, and represents a consensus of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology 4.
- spinal anatomy
- congential abnormalities of the spine
- spinal infection / inflammation / degeneration
- intervertebral disc
- intervertebral disc disease nomenclature
- lumbar disc disease
- acute calcific discitis
- acute disseminated encephalomyelitis (ADEM)
- Charcot-Marie-Tooth disease
- HIV vacuolar myelopathy
- HTLV-1 associated myelopathy (tropical spastic paraparesis)
- multiple sclerosis
- neuromyelitis optica (NMO) - (Devic's disease)
- transverse myelitis
- SCA3 (Machado-Joseph disease)
- subacute combined degeneration of the cord
- subacute necrotizing myelopathy
- tabes dorsalis
- spinal ischaemia
- spinal trauma
- spinal tumours and cysts
- spinal vascular malformations
- 1. Costello RF, Beall DP. Nomenclature and standard reporting terminology of intervertebral disk herniation. Magn Reson Imaging Clin N Am. 2007;15 (2): 167-74, v-vi. doi:10.1016/j.mric.2006.12.001 - Pubmed citation
- 2. Parnell AP. Cervical intradural disc protrusion. J. Neurol. Neurosurg. Psychiatr. 1989;51 (7): 1007. Free text at pubmed - Pubmed citation
- 3. Fardon DF, Milette PC. Nomenclature and classification of lumbar disc pathology. Recommendations of the Combined task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine. 2001;26 (5): E93-E113. Pubmed citation
- 4. Fardon DF, Williams AL, Dohring EJ et-al. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J. 2014;14 (11): . doi:10.1016/j.spinee.2014.04.022 - Pubmed citation