The
Demonstrates the normal lumbar disc anatomy: Here, in this over-head view, we have the nucleus pulposus (pink) surrounded by the the stronger annulus fibrosus (green). Normally, the annulus fibrosus is strong enough to contain or corral the pressurized nucleus pulposus and keep it from escaping (squirting) outward. Of particular interest to the upcoming discussion are the tiny 'Sinuvertebral Nerves Endings' (yellow poke-a-dots). These tiny nerve fibers, which are embedded within the posterolateral substance of the outer 1/3 of the annulus fibrosus, are known to both initiate and carry the perception of pain into the spinal cord. From there, these pain signals are carried upward to the sensory cortex of the brain. (386-388, 439).
ADVANCED: The pain pathways (how the pain gets from the disc to the brain) for discogenic pain are still very controversial and may not function as traditional anatomy has taught us. Traditionally, pain signals that originate in the nerve roots adjacent to the disc or in the disc move from that root, into the corresponding DRG and then into the spinal cord. However, some new research suggests that pain signals from the lower lumbar discs (L5 and L4) are (at least in part) detoured up the sympathetic nerves (i.e., gray ramus communicans) and into the upper lumbar DRGs - especially at the L2 level. (11, 259, 260) Clinically, in some patients it then would be possible for patients with L4 and L5 disc problems to have L1 or L2 dermatomal pain (groin and anterior thigh pain).
Saturday, June 15, 2013
Формирование межпозвоночной грыжи
Axial (overhead) Disc Anatomy:
The human disc has two basic parts: an inner Jell-O like center called the Nucleus Pulposus and the Annulus Fibrosis. Let learn more about each:
The
Demonstrates the normal lumbar disc anatomy: Here, in this over-head view, we have the nucleus pulposus (pink) surrounded by the the stronger annulus fibrosus (green). Normally, the annulus fibrosus is strong enough to contain or corral the pressurized nucleus pulposus and keep it from escaping (squirting) outward. Of particular interest to the upcoming discussion are the tiny 'Sinuvertebral Nerves Endings' (yellow poke-a-dots). These tiny nerve fibers, which are embedded within the posterolateral substance of the outer 1/3 of the annulus fibrosus, are known to both initiate and carry the perception of pain into the spinal cord. From there, these pain signals are carried upward to the sensory cortex of the brain. (386-388, 439).
ADVANCED: The pain pathways (how the pain gets from the disc to the brain) for discogenic pain are still very controversial and may not function as traditional anatomy has taught us. Traditionally, pain signals that originate in the nerve roots adjacent to the disc or in the disc move from that root, into the corresponding DRG and then into the spinal cord. However, some new research suggests that pain signals from the lower lumbar discs (L5 and L4) are (at least in part) detoured up the sympathetic nerves (i.e., gray ramus communicans) and into the upper lumbar DRGs - especially at the L2 level. (11, 259, 260) Clinically, in some patients it then would be possible for patients with L4 and L5 disc problems to have L1 or L2 dermatomal pain (groin and anterior thigh pain).
The
Demonstrates the normal lumbar disc anatomy: Here, in this over-head view, we have the nucleus pulposus (pink) surrounded by the the stronger annulus fibrosus (green). Normally, the annulus fibrosus is strong enough to contain or corral the pressurized nucleus pulposus and keep it from escaping (squirting) outward. Of particular interest to the upcoming discussion are the tiny 'Sinuvertebral Nerves Endings' (yellow poke-a-dots). These tiny nerve fibers, which are embedded within the posterolateral substance of the outer 1/3 of the annulus fibrosus, are known to both initiate and carry the perception of pain into the spinal cord. From there, these pain signals are carried upward to the sensory cortex of the brain. (386-388, 439).
ADVANCED: The pain pathways (how the pain gets from the disc to the brain) for discogenic pain are still very controversial and may not function as traditional anatomy has taught us. Traditionally, pain signals that originate in the nerve roots adjacent to the disc or in the disc move from that root, into the corresponding DRG and then into the spinal cord. However, some new research suggests that pain signals from the lower lumbar discs (L5 and L4) are (at least in part) detoured up the sympathetic nerves (i.e., gray ramus communicans) and into the upper lumbar DRGs - especially at the L2 level. (11, 259, 260) Clinically, in some patients it then would be possible for patients with L4 and L5 disc problems to have L1 or L2 dermatomal pain (groin and anterior thigh pain).
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