Internal Disc Disruption

• Disc-related pain - Internal Disc Disruption (IDD):

  • there may be some IDD and degradation of the nuclear matrix and presence of radio fissure extending from the nucleus pulposus to the annular fibrosis
  • the material from the nucleus pulposus does not herniate
  • May or may not cause referred symptoms depending on the grade and nerve involvement
  • Difficult to clinically discriminate between IDD and other structures causing pain and/or other symptoms
• Disc-related pain - Internal Disc Disruption (IDD):

  • Grade 1 - Early annular tear extends to the inner third of the disc
  • Grade 2 - More annular tear extends to middle third
  • Grade 3 - The tear extends to the outer third of the disc
  • Grade 4 - The same as grade 3 + circumferential spread in the outer third
  • pain increases as grade increases
  • grade 4 may be associated with a subtle disc bulge
  • level of pain also correlates with level of disc innovation - discs are less innovated centrally, so as material disrupts and extends to outer thirds, its more likely to be more painful

  
• Disc-related pain - Internal Disc Disruption (IDD):

  • disruption of the internal disk will affect the ability of the disk to sustain compression loads and how loads transfer from the nucleus pulposus to the annulus fibrosis and to the end plate themselves
  • therefore severe levels of internal disk disruption can lead to end plate fractures