Intervertebral disc disease nomenclature

Intervertebral disc disease nomenclature has changed over the years, and a familiarity with current definitions is essential if clear communication is to be achieved via radiology reports or referrals, especially as lumbar disc disease is a common problem and a source of a great deal of imaging. Terms such as bulge, protrusion, extrusion, sequestration and migration all have specific meanings although their definition varies from publication to publication.

A recent (2014) recommendation from The American Society of Spine Radiology, The American Society of Neuroradiology and The American Spine Society have been widely accepted, and are used in this, and related articles 3

Terminology

Disc

The following terms relating to intervertebral discs are recognised 3. A brief description is included for some; each is then discussed in more detail in separate articles. 

  • normal
  • desiccation
  • annular fissure
  • disc bulge: annular tissue projects beyond the margins of the adjacent vertebral bodies, over more than 90 degrees of circumference
    • circumferential bulge: involves the entire disc circumference
    • asymmetric bulge: does not involving the entire circumference, but more than 90 degrees
  • herniation
    • protrusionfocal protrusion of disc material beyond margins of adjacent vertebral body, over less than 90 degrees of circumference, with a base that is wider than dome
    • extrusion: focal herniation of disc nuclear material through an annular defect, remaining in continuity with the disc, with a base narrower than the dome of the extrusion
    • sequestration: distal migration of extruded disc material away form the disc, with no direct contiunation with the adjacent disc
  • pseudodisc of anterolisthesis: deformity of annular fibres due to anterolisthesis mimicking a true protrusion or bulge
Localisation

In the case of disc herniation then the abnormally displaced nucleus polposus should be described in terms of its position in both axial and sagittal planes.

Axial localisation

Most sizable disc herniations will occupy more than one zone:

  • central
  • subarticular, also known as lateral recess and paracentral
  • foraminal
  • extraforaminal, also known as lateral or far lateral
  • anterior
Sagittal localisation

The pedicle and disc are used as reference points. Disc herniation may extend to:

  • disc level: confined to between the vertebral endplates
  • suprapedicular: between superior endplate and the superior border of pedicle
  • pedicular: at the level of the pedicle
  • infrapedicular: below lower margin of the pedicle to the inferior endplate

Spine
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Article Information

rID: 5756
Tag: refs
Synonyms or Alternate Spellings:
  • Intervertebral disc nomenclature
  • IV disc nomenclature

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    Figure 1a: axial localisation
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    Figure 1b: sagittal localisation
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    Normal
    Figure 2a: normal
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    Figure 2b
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    Figure 3a: disc bulge
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    Fibure 3b: disc bulge
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    Figure 4a: disc protrusion
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    Figure 4b: disc protrusion
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    Figure 5b: disc extrusion
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    Figure 5a: disc extrusion
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    Figure 6: disc sequestration
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