Lumbar Disc Classification

Lumbar Disc Classification

Steven J. Gould, D.C., D.A.C.B.R.

Central Plains Radiologic Services, P.A.

P.O. Box 190 / 126 N. Main Cheney, KS. 67025 316-542-3400

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Bulging?

Herniated? Protrusion? Extruded? Sequestered?

How would you describe these disc configurations?

Ruptured? Prolapsed?

Free fragment?

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Controversies;

Lack of pathologic or morphologic definitions limits comparison of research study results.

Use of terms like "ruptured" disc may be alarming to patients where surgical intervention may not be the best option.

Legal settlements have been based on defined morphology of disc derangements.

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Classification of Lumbar Disc Pathology

Dicussion: Importance of using reliable terms for defining normal and pathologic changes of lumbar discs. Terms that can be interpreted accurately, consistently, and with precision for communicating impressions from imaging for clinical diagnostic and therapeutic decision making.

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Principles guiding standardization

Definitions should be based upon anatomy and pathology.

Definitions of diagnoses... ...should not be dependent upon or imply value of specific tests. ... should not define or imply external etiologic events such as trauma. ... should not imply relationship to symptoms. ...should not define or imply need for specific treatment.

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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 David F. Fardon, MD, Chairperson, Clinical Task Force Pierre C. Milette, MD, Chairperson, Imaging Task Force

Clinical Task Force Members Tom Faciszewski, MD David F. Fardon, MD Steven R. Garfin, MD Scott Haldeman, MD, PhD Neil Kahanovitz, MD Volker K.H. Sonntag, MD

Imaging Task Force Members Brigitte Appel, MD Jean-Fran?ois Bonneville, MD Marco Leonardi, MD Pierre C. Milette, MD Jeffrey S. Ross, MD Alan L. Williams, MD Jan T. Wilmink, MD, PhD

FEBRUARY 2003 UPDATE

Since its initial publication, in March 2001, the terminology proposed in this work has been endorsed by other societies. It is now officially supported, recommended or web-linked by the following American and European professional organizations and scientific societies:

American Academy of Orthopaedic Surgeons (AAOS) American Academy of Physical Medicine and Rehabilitation (AAPM&R)

American College of Radiology (ACR) American Society of Neuroradiology (ASNR) American Society of Spine Radiology (ASSR) Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons (AANS) and Congress of

Neurological Surgeons (CNS) European Society of Neuroradiology (ESNR)

North American Spine Society (NASS) Physiatric Association of Spine, Sports and Occupational Rehabilitation (PASSOR)



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Lumbar disc nomenclature: version 2.0

David F. Fardon, MD, Alan L. Williams, MD, Edward J. Dohring, MD, F. Reed Murtagh, MD, Stephen L. Gabriel Rothman, MD, Gordon K. Sze, MD

The Spine Journal Volume 14, Issue 11, Pages 2525-2545 (November 2014)

DOI: 10.1016/j.spinee.2014.04.022

Copyright ? 2014 The North American Spine Society, The American Society of Spine Radiology and The American Society of Neuroradiology Terms and Conditions

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The Spine Journal 2014 14, 2525-2545DOI: (10.1016/j.spinee.2014.04.022) Copyright ? 2014 The North American Spine Society, The American Society of Spine Radiology and The American Society of Neuroradiology Terms and Conditions

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Axial T2

Sagittal T2

Anatomy Review

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Annulus Fibrosus: Multilaminated ligament surrounding the periphery of each disc space, attaching craniad and caudad to the end-plate cartilage and ring apophyseal bone and blending centrally with the nucleus pulposus.

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Definitions; The Intervertebral disc

Nucleus Pulposus: Collagen and hydrophilic proteoglycans. Demarcation of the nucleus and annular fibers becomes more indistinct with age.

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Peridural Membrane: A delicate, translucent membrane that attaches to the undersuface of the deep layer of the PLL, and extends laterally and posteriorly, encircling the bony spinal canal outside the dura. The veins of Batson's plexus lie on the dorsal surface of the peridural membrane and pierce it ventrally. AKA lateral membrane, epidural membrane.

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