Pathophysiology of Herniated Nucleus Pulposus

Herniated intervertebral disc in all directions can occur due to trauma or physical stress. Herniated into the superior or inferior direction, through the cartilage plate into the vertebral body named as "Schmorl nodules" (usually found incidentally on radiological or autopsy picture). Most herniation occurs in the posterolateral direction with respect to the following factors: the nucleus pulposus which tend to be located further away in the posterior and the posterior longitudinal ligament which tends to reinforce the annulus fibrosus in the middle of the posterior. This event is also known by various other names such as rupture of the annulus fibrosus, Herniated Nucleus Pulposus, ruptured disc, pinched nerve and herniated discuc.

At first the nucleus pulposus, herniation occurs through a concentric ring the annulus fibrosus is torn, and causing another rings on the outside of a local stand still intact (Focal). Such a situation is called as Protusio Discus. If the process continues, the material nuclei will then slip out of the disc to the anterior ligament longitudinal posterior (disc herniation free fragment).

Usually protusio extraction posterolateral disc will hit the ipsilateral nerve root at the exit of nerves bag deva (eg disc herniation of L4 - L5 left will clamp the left L5 nerve root). Pinching the nerves will show symptoms and signs in accordance with the distribution redikuler innervation. Significant central disc herniation may involve some element of Cauda Equina on both sides, so that the display radiculopatia bilateral or even sphincter disorders such as urinary retention.

Discus hernia classification depends on the location of the affected is L5, pain that occurs in the sacroiliac joint, hip, lateral thigh and calf, medial leg (pain that radiates down the leg from the pelvis and is called Ishalgia)
Foot drop can lead to weakness and damage done dorsiflexion of the foot and toes or difficulty walking on heels, parastenia occurs in the distal lateral leg and foot middle toe between thumb. Atrophy is not clear, reflexes are usually not real, knee or ankle reflexes may be lost.