Classification and Imaging Study of the Lumbar Disc Herniation

Lee, Hwan Mo; Park, Moon Soo

Abstract

It is known that the lifetime prevalence of low back pain approximates 80%, with long standing low back problems in roughly 10% to 20% of the population. The symptoms of sciatica due to nerve root compression most often relate to aberration of the lumbar intervertebral disc. Lumbar disc herniation is defined as herniation of nucleus and/or anulus fibrosus through the tear of the anulus fibrosus. According to the degree, it has been classified as a bulging disc, a protruded disc, a extruded disc, and a sequestrated disc. Also it has been classified as central, posterolateral, and foraminal herniation by the location of the herniation. The four imaging studies most frequently ordered to evaluate lumbar disc herniation are plain x-ray films, myelography, computed tomography, and magnetic resonance imaging. Each test provides useful information about lumbar disc herniation. However, before the selection of a test, the category of the clinical problem must be defined and imaging abnormalities must be correlated with historical and physical findings. Many errors in decision making with imaging studies of lumbar disc herniation do not come from misinterpretation of what in seen on the images; instead, they are related to how the imaging information is used and integrated into the clinical decision-making process.