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An intervertebral disc (or intervertebral fibrocartilage) lies between adjacent
vertebra The spinal column, a defining synapomorphy shared by nearly all vertebrates,Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristic ...
e in the
vertebral column The vertebral column, also known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord (a flexible rod of uniform composition) found in all chordata, ...
. Each disc forms a
fibrocartilaginous Fibrocartilage consists of a mixture of white fibrous tissue and cartilaginous tissue in various proportions. It owes its inflexibility and toughness to the former of these constituents, and its Elasticity (physics), elasticity to the latter. It ...
joint A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw ...
(a
symphysis A symphysis (, pl. symphyses) is a fibrocartilaginous fusion between two bones. It is a type of cartilaginous joint, specifically a secondary cartilaginous joint. # A symphysis is an amphiarthrosis, a slightly movable joint. # A growing together ...
), to allow slight movement of the vertebrae, to act as a
ligament A ligament is the fibrous connective tissue that connects bones to other bones. It is also known as ''articular ligament'', ''articular larua'', ''fibrous ligament'', or ''true ligament''. Other ligaments in the body include the: * Peritoneal li ...
to hold the vertebrae together, and to function as a shock absorber for the spine.


Structure

Intervertebral discs consist of an outer fibrous ring, the anulus fibrosus disci intervertebralis, which surrounds an inner gel-like center, the nucleus pulposus. The ''anulus fibrosus'' consists of several layers (laminae) of
fibrocartilage Fibrocartilage consists of a mixture of white fibrous tissue and cartilaginous tissue in various proportions. It owes its inflexibility and toughness to the former of these constituents, and its elasticity to the latter. It is the only type of ...
made up of both type I and
type II collagen Type II collagen is the basis for hyaline cartilage, including the articular cartilages at joint surfaces. It is formed by homotrimers of collagen, type II, alpha 1 chains. It makes up 50% of all protein in cartilage and 85–90% of collagen of a ...
. Type I is concentrated toward the edge of the ring, where it provides greater strength. The stiff laminae can withstand compressive forces. The fibrous intervertebral disc contains the ''nucleus pulposus'' and this helps to distribute pressure evenly across the disc. This prevents the development of stress concentrations which could cause damage to the underlying vertebrae or to their
endplates The spinal column, a defining synapomorphy shared by nearly all vertebrates,Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristic i ...
. The nucleus pulposus contains loose fibers suspended in a mucoprotein gel. The nucleus of the disc acts as a shock absorber, absorbing the impact of the body's activities and keeping the two vertebrae separated. It is the remnant of the
notochord In anatomy, the notochord is a flexible rod which is similar in structure to the stiffer cartilage. If a species has a notochord at any stage of its life cycle (along with 4 other features), it is, by definition, a chordate. The notochord consis ...
. There is one disc between each pair of vertebrae, except for the first cervical segment, the ''
atlas An atlas is a collection of maps; it is typically a bundle of maps of Earth or of a region of Earth. Atlases have traditionally been bound into book form, but today many atlases are in multimedia formats. In addition to presenting geographic ...
''. The ''atlas'' is a ring around the roughly cone-shaped extension of the ''
axis An axis (plural ''axes'') is an imaginary line around which an object rotates or is symmetrical. Axis may also refer to: Mathematics * Axis of rotation: see rotation around a fixed axis *Axis (mathematics), a designator for a Cartesian-coordinate ...
'' (second cervical segment). The axis acts as a post around which the atlas can rotate, allowing the neck to swivel. There are 23 discs in the human spine: 6 in the neck (
cervical In anatomy, cervical is an adjective that has two meanings: # of or pertaining to any neck. # of or pertaining to the female cervix: i.e., the ''neck'' of the uterus. *Commonly used medical phrases involving the neck are **cervical collar **cervic ...
) region, 12 in the middle back (
thoracic The thorax or chest is a part of the anatomy of humans, mammals, and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main divisions of the crea ...
) region, and 5 in the lower back (
lumbar In tetrapod anatomy, lumbar is an adjective that means ''of or pertaining to the abdominal segment of the torso, between the diaphragm and the sacrum.'' The lumbar region is sometimes referred to as the lower spine, or as an area of the back i ...
) region Discs are named by the vertebral body above and below. For example, the disc between the fifth and sixth cervical vertebrae is designated "C5-6".


Development

During development and at birth, vertebral discs have some vascular supply to the cartilage endplates and the anulus fibrosus. These quickly deteriorate leaving almost no direct blood supply in healthy adults.


Intervertebral disc space

The intervertebral disc space is typically defined on an
X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10  picometers to 10  nanometers, corresponding to frequencies in the range 30&nb ...
photograph as the space between adjacent
vertebrae The spinal column, a defining synapomorphy shared by nearly all vertebrates,Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristic i ...
. In healthy patients, this corresponds to the size of the intervertebral disc. The size of the space can be altered in pathological conditions such as
discitis Discitis, or diskitis, is an infection in the intervertebral disc space that affects different age groups. In adults, it can lead to severe consequences, such as sepsis or epidural abscess, but it can also spontaneously resolve, especially in chi ...
(infection of the intervertebral disc).


Function

The intervertebral disc functions to separate the vertebrae from each other and provides the surface for the shock-absorbing gel of the nucleus pulposus. The nucleus pulposus of the disc functions to distribute hydraulic pressure in all directions within each intervertebral disc under compressive loads. The nucleus pulposus consists of large vacuolated notochord cells, small chondrocyte-like cells,
collagen Collagen () is the main structural protein in the extracellular matrix found in the body's various connective tissues. As the main component of connective tissue, it is the most abundant protein in mammals, making up from 25% to 35% of the whole ...
fibrils, and
aggrecan Aggrecan (ACAN), also known as cartilage-specific proteoglycan core protein (CSPCP) or chondroitin sulfate proteoglycan 1, is a protein that in humans is encoded by the ''ACAN'' gene. This gene is a member of the lectican (chondroitin sulfate prote ...
, a
proteoglycan Proteoglycans are proteins that are heavily glycosylated. The basic proteoglycan unit consists of a "core protein" with one or more covalently attached glycosaminoglycan (GAG) chain(s). The point of attachment is a serine (Ser) residue to whic ...
that aggregates by binding to
hyaluronan Hyaluronic acid (; abbreviated HA; conjugate base hyaluronate), also called hyaluronan, is an anionic, nonsulfated glycosaminoglycan distributed widely throughout connective, epithelial, and neural tissues. It is unique among glycosaminoglycans ...
. Attached to each aggrecan molecule are glycosaminoglycan (GAG) chains of
chondroitin sulfate Chondroitin sulfate is a sulfated glycosaminoglycan (GAG) composed of a chain of alternating sugars ( N-acetylgalactosamine and glucuronic acid). It is usually found attached to proteins as part of a proteoglycan. A chondroitin chain can have ove ...
and
keratan sulfate Keratan sulfate (KS), also called keratosulfate, is any of several sulfated glycosaminoglycans (structural carbohydrates) that have been found especially in the cornea, cartilage, and bone. It is also synthesized in the central nervous system w ...
. Increasing the amount of negatively charged aggrecan increases
oncotic pressure Oncotic pressure, or colloid osmotic-pressure, is a form of osmotic pressure induced by the proteins, notably albumin, in a blood vessel's plasma (blood/liquid) that causes a pull on fluid back into the capillary. Participating colloids displace ...
, resulting in a shift of extracellular fluid from the outside to the inside of the nucleus pulposus. The amount of glycosaminoglycans (and hence water) decreases with age and degeneration.


Clinical significance

Anything arising from the intervertebral disc may be termed discogenic in particular when referring to associated pain as ''discogenic pain''.


Herniation

A spinal disc herniation, commonly referred to as a slipped disc, can happen when unbalanced mechanical pressures substantially deform the anulus fibrosus, allowing part of the nucleus to obtrude. These events can occur during peak physical performance, during traumas, or as a result of chronic deterioration (typically accompanied with poor posture), and has been associated with a ''Propionbacterium acnes'' infection. Both the deformed anulus and the gel-like material of the nucleus pulposus can be forced laterally or posteriorly, distorting local muscle function and putting pressure on the nearby nerve. This can give symptoms typical of nerve root entrapment, which can vary between paresthesia, numbness, chronic and/or acute pain, either locally or along the dermatome served by the entrapped nerve, loss of muscle tone and decreased homeostatic performance. The disc is not physically slipped; it bulges, usually in just one direction. Another kind of herniation, of the nucleus pulposus, can happen as a result of the formation of Schmorl's nodes on the intervertebral disc. This is referred to as ''vertical disc herniation''.


Degeneration

Before age 40, approximately 25% of people show evidence of disc degeneration at one or more levels. Beyond age 40, more than 60% of people show evidence of disc degeneration at one or more levels on
magnetic resonance imaging Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio wave ...
(MRI). These degenerative changes are a normal part of the ageing process and do not correlate to pain. One effect of aging and disc degeneration is that the nucleus pulposus begins to dehydrate and the concentration of proteoglycans in the matrix decreases, thus limiting the ability of the disc to absorb shock. This general shrinking of disc size is partially responsible for the common decrease in height as humans age. The anulus fibrosus also becomes weaker with age and has an increased risk of tearing. In addition, the cartilage endplates begin thinning, fissures begin to form, and there is sclerosis of the subchondral bone. Since the fissures are formed in the anulus fibrosus due to osteo-arthritic bones or degeneration in general, the inner nucleus pulposus can seep out and put pressure on any number of vertebral nerves. A herniated disc can cause mild to severe pain such as
sciatica Sciatica is pain going down the leg from the lower back. This pain may go down the back, outside, or front of the leg. Onset is often sudden following activities like heavy lifting, though gradual onset may also occur. The pain is often described ...
and treatment for herniated discs range from physical therapy to surgery.(see also:
Intervertebral disc arthroplasty Artificial disc replacement (ADR), or total disc replacement (TDR), is a type of arthroplasty. It is a surgical procedure in which degenerated intervertebral discs in the spinal column are replaced with artificial disc implants in the lumbar (l ...
) Other degeneration of the vertebral column includes
diffuse idiopathic skeletal hyperostosis Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by abnormal calcification/bone formation (hyperostosis) of the soft tissues surrounding the joints of the spine, and also of the peripheral or appendicular skeleton. In ...
(DISH) which is the calcification or ossification of the ligaments surrounding the vertebrae. This degeneration causes stiffness and sometimes even curvature in the lumbar and thoraco-lumbar spinal region. Burgeoning evidence suggests that long-term running may mitigate age-related degeneration within lumbar intervertebral discs


Scoliosis

While this may not cause pain in some people, in others it may cause chronic pain. Other spinal disorders can affect the morphology of intervertebral discs. For example, patients with
scoliosis Scoliosis is a condition in which a person's spine has a sideways curve. The curve is usually "S"- or "C"-shaped over three dimensions. In some, the degree of curve is stable, while in others, it increases over time. Mild scoliosis does not t ...
commonly have calcium deposits (ectopic calcification) in the cartilage endplate and sometimes in the disc itself. Herniated discs are also found to have a higher degree of cellular senescence than non-herniated discs. In addition to scoliosis, which is the lateral 'S' curvature of the spine, the fused vertebrae can also experience other abnormalities such as kyphosis (hunchback) which shows in old age, or lordosis (swayback), which is often present in pregnancy and obesity.


Etymology

The Latin word ''anulus'' means "little ring"; it is the diminutive of ''anus'' ("ring"). The misspelling ''annulus'' is also common.Federative Committee on Anatomical Terminology (FCAT) (1998). ''Terminologia Anatomica''. Stuttgart: Thieme


Additional images

Image:Annulus Fibrosus.png, Anulus fibrosus. Image:Vertebre-IMG 0032.jpg, Artificial intervertebral disc. Image:Gray302.png, Posterior longitudinal ligament, in the thoracic region. Image:Gray308.png, Median sagittal section through the occipital bone and first three cervical vertebrae. Image:Gray312.png, Costovertebral articulations. Anterior view. File:Slide1gt.JPG, Lumbar and sacral plexus. Deep dissection. Anterior view. File:Slide2gt.JPG, Lumbar and sacral plexus. Deep dissection. Anterior view. Invertebral disc polarised light microscopy image by Claudio Vergari (27177975104).jpg, Polarised light microscopy image of the annulus fibrosus, showing the concentric layers of fibrous tissue.


See also

*
Back pain Back pain is pain felt in the back. It may be classified as neck pain (cervical), middle back pain (thoracic), lower back pain (lumbar) or coccydynia (tailbone or sacral pain) based on the segment affected. The lumbar area is the most common area ...
*
Degenerative disc disease Degenerative disc disease (DDD) is a medical condition typically brought on by the normal aging process in which there are anatomic changes and possibly a loss of function of one or more intervertebral discs of the spine. DDD can take place with ...
*
Spinal decompression Spinal decompression is the relief of pressure on the spinal cord or on one or more compressed nerve roots passing through or exiting the spinal column. Decompression of the spinal neural elements is a key component in treating spinal radiculopath ...
*
Lumbar spinal stenosis Lumbar spinal stenosis (LSS) is a medical condition in which the spinal canal narrows and compresses the nerves and blood vessels at the level of the lumbar vertebrae. Spinal stenosis may also affect the cervical or thoracic region, in which case ...


References


External links


Intervertebral DiscsSpinal Disc Summary
* {{Use dmy dates, date=April 2017 Skeletal system Soft tissue Back anatomy Bones of the vertebral column