Epidemiology

Back pain alone is no indication of the presence of a herniated disc. In general, it is very difficult to find the causes of back pain. Even X-rays cannot always provide the desired clarity.

In order to show that back pain and the actual presence of a pathological (= pathological) disc finding are not always mandatory, the study by Jensen will be cited here as an example. This randomized, controlled study worked with MRI examinations of the lumbar spine and examined symptom-free people. The results are astonishing: In 52% of the patients a protrusion of the intervertebral disc (= protrusio, also called disc protrusion or disc protrusion) could be detected.

In 27 % a herniated disc could be diagnosed and in addition, 1% of the patients had a herniated disc that was already pressing on the surrounding tissue. In 38 % of all patients the changes were not limited to one intervertebral disc. It is alarming that only about 33% of all those examined stated that they suffered from back pain.

This makes it clear that diagnostic accuracy can only be achieved if diagnostic measures are taken as completely as possible. Different symptoms must always be distinguished from each other in order to be able to make a reliable diagnosis of “slipped disc“. Herniated discs occur most frequently in the lumbar spine, followed by herniated discs in the cervical spine.

Herniated discs in the thoracic spine are relatively rare as another possibility. While lumbar spine prolapses occur most frequently between the ages of 30 and 50, the cervical spine is affected later between the ages of 40 and 60. A disc protrusion (disc protrusion, see below) can occur much earlier. In the further course of life, herniated disks are then again less frequent, since the loss of water from the disk then occurs more frequently. With regard to the herniated disc, this has the “advantage” that the gelatinous core becomes more viscous and thus can only occur with difficulty.

Differentiation herniated disc

In the context of a herniated disc one differentiates between: You should think of it like this: Prolapsed areas of the intervertebral disc can press more or less strongly on nerve roots that are directly adjacent to the disc. In the lower lumbar region, this includes the sciatic nerve, which can cause very severe pain when pressure is applied (sciatic pain = sciatica). – A disc protrusion (picture below), which leads to a bulge of the annulus fibrosus,

A disc prolapse (= herniated disc; picture below) into the intervertebral holes or – which occurs much less frequently – into the spinal canal.
A sequestration, as a result of which the prolapsed parts no longer have any connection with the original disc. – In the case of a disc protrusion, the disc as such remains intact at first. The inner gelatinous core bulges forward and presses on the cartilaginous outer ring consisting of connective tissue.
In a nucleus pulposus prolapse (NPP), however, the gelatinous core partially emerges through the outer ring. However, the part that exits remains connected to the remaining inner gelatinous core and does not encapsulate itself. – In sequestration, on the other hand, the exuded area is encapsulated: The prolapsed part of the gelatinous core is no longer connected to the inner area. – Nucleus pulposus (gelatinous core)
Anulus fibrosus (fibrous ring)
Nucleus pulposus
Anulus fibrosus (fibrous ring)
Projection
Nucleus pulposus
Anulus fibrosus (fibrous ring)
Incident