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Advanced Concepts in Lumbar Degenerative Disk Disease pp 23–39Cite as

Lumbar Intervertebral Disk Injury, Herniation and Degeneration

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Abstract

This chapter reviews the mechanical function and failure of lumbar intervertebral discs. Disc herniation is essentially a bending injury to the annulus that can also involve the nucleus and vertebral endplate. Injuries to the annulus and vertebral body endplate create two distinct ‘phenotypes’ of disc degeneration: annulus driven and endplate driven. Either injury alters the mechanical environment of disc cells. Disturbed cell biology can lead to altered matrix composition, further structural disruption, revascularisation, reinnervation and pain. This defines the process of ‘disc degeneration’. A disc’s attempts to repair itself are frustrated by the very low cell density in the nucleus, which itself is attributable to poor metabolite transport. Disc injuries need not be traumatic, because intervertebral discs can be so weakened by genetic inheritance, ageing and loading history that injury occurs during the activities of everyday living. The situation is analogous to vertebral osteoporotic fracture. Medicolegal implications are considered.

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Authors and Affiliations

  1. Centre for Comparative and Clinical Anatomy, University of Bristol, Southwell Street, Bristol, BS2 8EJ, UK

    Michael A. Adams BSc, PhD & Patricia Dolan BSc, PhD

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  1. Michael A. Adams BSc, PhD
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  2. Patricia Dolan BSc, PhD
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Correspondence to Michael A. Adams BSc, PhD .

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  1. Neurological and Spine Surgery, Hospital Samaritano, São Paulo, São Paulo, Brazil

    João Luiz Pinheiro-Franco

  2. Rothman Institute, Thomas Jefferson University Medical Center, Philadelphia, Pennsylvania, USA

    Alexander R. Vaccaro

  3. Cleveland Clinic Neurological Surgery, Cleveland, Ohio, USA

    Edward C. Benzel

  4. Schön Klinik München Harlaching FG Wirbelsäulenchirurgie, München, Germany

    H. Michael Mayer

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© 2016 Springer-Verlag Berlin Heidelberg

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Adams, M.A., Dolan, P. (2016). Lumbar Intervertebral Disk Injury, Herniation and Degeneration. In: Pinheiro-Franco, J., Vaccaro, A., Benzel, E., Mayer, H. (eds) Advanced Concepts in Lumbar Degenerative Disk Disease. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-47756-4_3

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  • DOI: https://doi.org/10.1007/978-3-662-47756-4_3

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-47755-7

  • Online ISBN: 978-3-662-47756-4

  • eBook Packages: MedicineMedicine (R0)

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