Herniated disc is common. Researchers believe that degeneration plays an integral role with herniation and is thought to be considered the main cause of back pain.
But the exact mechanisms on what causes the pain in different patients remains elusive. That is, some patients with degeneration will not present with a sore back and this can also be the case with herniated disc. On the other hand, intervertebral disc degeneration and herniated disc can cause intense disability.
Because the disc is mainly water and collagen, imaging techniques like MRI can be used to assess the microstructure to evaluate whether or not pain is related to the disc. But MRI cannot always tell you the whole story. One of the more current techniques used is called T2 mapping. This is a specific MRI setting that looks closer at the disc…namely the back side of the disc or scientifically known as the ‘posterior annulus’.
In a recent study 3 researchers concluded that looking closely at the back of the disc can provide clues about its structural weakening in the early prevention of a full herniation. They believed that T2 MRI mapping can be a useful tool for radiologists. This in turn can help distinguish those at risk of a full herniation.
In my office, I will investigate any MRI carefully, looking at the posterior annulus. This, combined with a detailed history will lead me into identifying those at risk of a full herniation.
I often will use my models to help the patient understand the basics of spinal motion. Once I teach them how the lumbar spine is best loaded in a lordotic state, they are well on their way to healing and preventing a herniated disc.
- Carragee EJ (2005) Clinical practice. Persistent low back pain. N Engl J Med 352(18):1891–1898 ↩
- Battie MC, Videman T (2006) Lumbar disc degeneration: epidemiology and genetics. J Bone Joint Surg Am 88(Suppl 2):3–9 ↩
- Alina Messner • David Stelzeneder • Stefan Trattnig • Go¨tz H. Welsch • Martina Schinhan • Sebastian Apprich • Martin Brix • Reinhard Windhager • Siegfried Trattnig Does T2 mapping of the posterior annulus fibrosus indicate the presence of lumbar intervertebral disc herniation? A 3.0 Tesla magnetic resonance study Eur Spine J DOI 10.1007/s00586-016-4873-x ↩