Intervertebral Disc Damage (Discopathy)

In discopathy – colloquially called disc damage – (synonyms: Disc disease; discopathy; disc hernia; disc herniation; nucleus pulposus protrusion; disc prolapse; ICD-10-GM M51.9: disc damage, unspecified) is usually a disc prolapse (herniated disc; nucleus pulposus protrusion). This usually occurs in the lumbar spine (lumbar spine), but can also occur in the cervical spine (cervical spine). The preliminary stage of a herniated disc is called a bulging disc (protrusion).

In a herniated disc (BSP), the inner part of the intervertebral disc (discus intervertebralis), the nucleus propulsus (internal gelatinous nucleus), is pressed backwards by the annulus fibrosus (connective tissue ring of the intervertebral disc) in the direction of the spinal canal (spinal canal) out of the bed of the intervertebral disc between the vertebral bodies. In most cases, the nucleus enters the canal laterally in the process, so that individual outgoing nerve roots are compressed and lead to the symptoms described.

The prerequisite for a disc prolapse is given by a degeneration of the disc with formations of small tears in the annulus fibrosus.

In a disc protrusion, the annulus fibrosus remains intact.

The severity of discopathy is defined as follows:

  • Protrusion with protrusion of the annulus fibrosus.
  • Prolapse into the foramina vertebralia (intervertebral holes) or, more rarely, into the spinal canal (vertebral canal) after perforation (piercing) of the ligamentum longitudinale posterius (posterior longitudinal ligament)
  • Sequestration, i.e., the prolapsed portions (sequestrum) have no connection with the intervertebral disc

The discogenic (disc-related) triggered specific back pain can be divided into two subgroups:

  • Localized back pain discogenically caused – usually triggered by median lying disc prolapse (BSP/disc herniation; breakthrough of the annulus fibrosus/fibrous ring), more rarely by pure protrusion (disc protrusion; partially or completely preserved annulus).
  • Radiculopathy (irritation or damage to nerve roots) resulting from disc herniation – BSP with mediolateral (“from the middle toward the side”) or lateral (“to the side”) location; thereby compressing descending fibers or the radices (roots) of spinal nerves

Sex ratio: males and females are equally affected.

Frequency peak: the disease occurs mainly from middle age. The average age of onset of a herniated disc is between 46 and 55 years.

The incidence (frequency of new cases) is approximately 150 cases per 100,000 inhabitants per year (in Germany).

Course and prognosis: Often, disc damage does not cause any symptoms. Occurring pain can be well alleviated by adequate pharmacotherapy (drug treatment) and relaxed positioning (step positioning). The pain may be localized or may radiate to the arms or legs (cervicobrachialgia). However, if the nerve compression (constriction of nerves) leads to stressful neurological disorders, surgical intervention is usually required. For example, hypesthesias (numbness) or paresthesias (“ant tingling”) may occur in the extremities (arms and legs). If urinary bladder or rectal disorders are present, surgery (partial hemilaminectomy with nucleotomy/removal of the affected disc) is usually required.