MRI Lumbar Spine
The basic principles of the MRI scan of the lumbar spine.
Pathology - Discus Herniation
The classification and terminology related to disc herniation have been approached by various disciplines (especially radiology and neurosurgery) over the past few decades. The currently most widely used terminology was jointly developed by three major organizations: the North American Spine Society, the American Society of Spine Radiology, and the American Society of Neuroradiology. In this module, the 'Lumbar Disc Nomenclature 2.0' will be used.
In practice, various terms are often used interchangeably for the displacement of disc material, with the risk of incorrect descriptions. A commonly used term following the current terminology is 'disc herniation.' Disc herniation is defined as the 'local displacement of nucleus pulposus/cartilage/fragmented bone (ring) apophysis and/or fragmented annulus tissue.' Displacement occurs when the tissue is located outside the vertebral apophysis boundary or beyond the vertebral endplates (i.e., Schmorl's herniation).
Fun fact: Strictly speaking, the original (old-fashioned) term 'HNP' ('hernia nucleus pulposi') is not entirely correct because not ONLY the nucleus pulposus can herniate. However, 'HNP' remains a familiar term used in clinical practice.
For the general description of disc herniation, the following three terms are recommended (fig. 26):
- Focal disc herniation: < 25% of disc size
- Broad-based disc herniation: 25-50% of disc size
- Bulging disc: > 50% of disc size
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Text
drs. A. van der Plas (MSK radiologist Maastricht UMC+)
With special thanks to:
dr. W. Henneman (neuroradiologist Maastricht UMC+)
Illustrations
drs. A. van der Plas (MSK radiologist Maastricht UMC+)
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08/10/2023
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