Citation, DOI, disclosures and article data
At the time the article was created Frank Gaillard had no recorded disclosures.View Frank Gaillard's current disclosures
At the time the article was last revised Frank Gaillard had no recorded disclosures.View Frank Gaillard's current disclosures
Intervertebral discs form the articulations between adjacent vertebral bodies from C2 to S1, thus forming 23 in total (although segmentation variations are not uncommon). Together they account for ~25% of the total height of the vertebral column which decreases with age as disc height is lost through normal aging.
The intervertebral discs are secondary cartilaginous joints, also known as symphyses 7.
Each intervertebral disc is comprised of:
- peripheral annulus fibrosus
- central nucleus pulposus
- hyaline cartilage (vertebral side) and fibrocartilage (nucleus pulposus side)
Above and below the intervertebral disc are the vertebral body endplates.
The upper thoracic discs are the thinnest and in general thoracic discs are the same width anteriorly as they are posteriorly. This is not the case in the cervical and lumbar spine, where greater thickness anteriorly contributes to the normal cervical and lumbar lordosis.
Intervertebral discs represent a hydromechanical system of load cushioning. Specifically, compressive forces act on the nucleus pulposus; on the annulus fibrosus, tensile stresses prevail 3-5.
Whilst the nucleus pulposus lacks arterial supply throughout life, other components of the intervertebral disc are variably supplied, depending on the age of the person. Unfortunately, the specific arteries providing much of this supply remains poorly described 8.
- nucleus pulposus: lacks a blood supply throughout life
- cartilaginous endplates
- children: vascularity is present throughout fetal life and into infancy, but during the first decade of life is a precipitous reduction in the number of blood vessels
- adults: avascular
- annulus fibrosus
- periphery: extensive vascularity in children and adults
- children: rich vascularization
- adults: lacks a blood supply
The avascular components of the discs receive nutrition via diffusion across the vertebral body endplates.
Historically, it was thought that the intervertebral discs lacked any lymphatic drainage. It is now clear that the spine and associated structures possess lymphatics, although the exact routes of the lymphatic vessels remain under active research (c. 2021) 6.
The outer fibers of the annulus fibrosus are innervated by sinuvertebral nerves arising from the dorsal root ganglia. The inner layers of the annulus fibrosus and nucleus pulposus lack any innervation 9.
- 1. Standring S (editor). Gray's Anatomy (39th edition). Churchill Livingstone. (2011) ISBN:0443066841. Read it at Google Books - Find it at Amazon
- 2. RF Costello, DP Beall "Nomenclature and standard reporting terminology of intervertebral disc herniation" Magn Reson Imaging Clin N Am 15 (2007) 167-174
- 3. Franco Postacchini. Le ernie discali lombari. (1997) ISBN: 9788872871287
- 4. L. Simonetti, R. Agati, F. De Santis, M. Leopardi: Anatomia e fisiopatologia dell’unità funzionale disco-somatica. Rivista di Neuroradiologia 14 (suppl. 1): 7-16, 2001.
- 5. G. F. Pistolesi, Ivo Andrea Bergamo Andreis. L'imaging diagnostico del rachide. (1987) ISBN: 9788877490254
- 6. Proulx ST. Cerebrospinal fluid outflow: a review of the historical and contemporary evidence for arachnoid villi, perineural routes, and dural lymphatics. (2021) Cellular and molecular life sciences : CMLS. 78 (6): 2429-2457. doi:10.1007/s00018-020-03706-5 - Pubmed
- 7. Chummy S. Sinnatamby. Last's Anatomy. (2020) ISBN: 9780702033957
- 8. Fournier DE, Kiser PK, Shoemaker JK, Battié MC, Séguin CA. Vascularization of the human intervertebral disc: A scoping review. (2020) JOR spine. 3 (4): e1123. doi:10.1002/jsp2.1123 - Pubmed
- 9. Groh AMR, Fournier DE, Battié MC, Séguin CA. Innervation of the human intervertebral disc: a scoping review. (2021) Pain medicine (Malden, Mass.). doi:10.1093/pm/pnab070 - Pubmed