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Modic type endplate changes represent a classification for vertebral body end-plate MRI signal, first described in 1988 2 . It is widely recognised by radiologists and clinicians and is a useful shorthand for reporting MRIs of the spine. Recently Modic type I has received renewed attention due to the possibility of it representing low grade indolent infection. It is thus discussed separately here. Modic type I o T1: low signal o T2: high signal o represents bone marrow oedema and inflammation Modic type II o T1: high signal o T2: iso to high signal o represents normal red haemopoietic bone marrow conversion into yellow fatty marrow as a result of marrow ischaemia Modic type III o T1: low signal o T2: low signal o represents subchondral bony sclerosis MC type I ( arrows ): hypointense on T1WI ( a ) and hyperintense on T2WI ( b) MC type II ( arrows ): hyperintense on T1WI ( a ) and isointense or hyperintense on T2WI ( b ) MC type III ( arrows ): hypointense on T1WI ( a ) and hypointense on T2WI ( b ) Glossary Note: Some terms and definitions included in this glossary are not recommended as preferred terminology but are included to facilitate the interpretation of vernacular and, in some cases, improper use. Preferred definitions are listed first. Nonstandard definitions are placed in brackets and, by

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Modic type endplate changes represent a classification for vertebral body end-plate MRI signal, first described in 1988 2. It is widely recognised by radiologists and clinicians and is a useful shorthand for reporting MRIs of the spine.Recently Modic type I has received renewed attention due to the possibility of it representing low grade indolent infection. It is thus discussed separately here. Modic type Io T1: low signalo T2: high signalo represents bone arrow oedea and inflaation Modic type IIo T1: high signalo T2: iso to high signalo represents noral red haeopoietic bone arrow conversion into yellow fatty arrow as a result of arrow ischaeia Modic type IIIo T1: low signalo T2: low signalo represents subchondral bony sclerosisMC type I (arrows): hypointense on T1WI (a) and hyperintense on T2WI(b)MC type II (arrows): hyperintense on T1WI (a) and isointense or hyperintense on T2WI (b)MC type III (arrows): hypointense on T1WI (a) and hypointense on T2WI(b)!lossaryNote: "oe ters and definitions included in this glossary are not recoended as preferred terinology but are included to facilitate the interpretation of vernacular and, in soe cases, iproper use. #referred definitions are listed first. $onstandard definitions are placed in brac%ets and, by consensus of the organi&ational tas% forces, should not be used in the anner described. "oe ters are also labeled ascollo'uial, with further designation as to whether they are considered nonpreferred or nonstandard.Acute disc herniation( )isc herniation of a relatively recent occurrence. Note: #aradiscal inflaatory reaction and relatively bright signal of thedisc aterial on *2-weighted iages suggest relative acuteness. "uch changes ay persist for onths, however. *hus, absent clinical correlation and+or serial studies, it is not possible to date precisely by iaging when a herniation occurred. ,n acutely herniated disc aterial ay have brighter signal on *2-weighted MRI se'uences than the disc fro which the disc aterial originates.-./,09,/.,/81 $ote that a relatively acute herniation can be superiposed on a previously e2isting herniation. ,n acute disc herniation ay regress spontaneously without specific treatent. "ee chronic disc herniation.Aging disc( )isc deonstrating any of the various effects of aging on the disc. 3oss of water content fro the nucleus occurs before MRI changes, followed by the progression of MRI-anifested changes consistent with the progressive loss of water content and increase in collagen and aggregating proteoglycans. "ee #firrann classification.Annular fissure( "eparations between annular fibers, separations of fibers fro their vertebral body insertions, or separations of fibers that e2tend radially, transversely, or concentrically, involving 1 or any layers of the annular laellae. $ote that the ters 4fissure4 and 4tear4 have often been used synonyously in the past. *he ter 4tear4 is inappropriate for use in describing iaging findings and should not be used 5tear( nonstandard6. $either ter suggests in7ury or iplies any %nowledge of etiology, neither ter iplies any relationship to syptos or that the disc is a li%ely pain generator, and neither ter iplies any need for treatent. ,lso, see annular gap, annular rupture, annular tear, concentric fissure, 8I9, radial fissure, transverse fissure.Annular gap 5nonstandard6( :ocal attenuation 5;*6 or signal 5MRI6 abnorality, oftentriangular in shape, in the posterior aspect of the disc, li%ely representing widening ofa radially directed annular fissure, bilateral annular fissures with an avulsion of the interediate annular fragent, or an avulsion of a focal &one of acerated annulus.Annular rupture( )isruption of fibers of the annulus by a sudden violent in7ury. *his isa clinical diagnosis< use of the ter is inappropriate for a pure iaging description, which instead should focus on a detailed description of the findings. Ruptured annulus is not synonyous with 4annular fissure4 or 4ruptured disc.4Annular tear, torn annulus 5nonstandard6( "ee fissure of the annulus and rupture of annulus.Anterior displacement( )isplaceent of disc tissues beyond the disc space into the anterior &one.Anterior zone( #eridiscal &one that is anterior to the idcoronal plane of the vertebral body.Anulus, annulus (abbreviated form of annulus fibrosus)( Multilainated fibrous tissueforing the periphery of each disc space, attaching, craniad and caudad, to endplate cartilage and a ring apophyseal bone, and blending centrally with the nucleus pulposus. Note: =ither anulus or annulus is correct spelling. Nomina Anatomica uses both fors, whereas Terminologia Anatomica states 4anulus fibrosus.4-221 :ibrosus has no correct alternative spelling< fibrosis has a different eaning and is incorrect in this conte2t.Asymmetric bulge( #resence of ore than 20> of the outer annulus beyond the perieter of the ad7acent vertebrae, ore evident in one section of the periphery of the disc than in another but not sufficiently focal to be characteri&ed as a protrusion. Note: ,syetric disc bulging is a orphological observation that ay have various causes and does not iply etiology or association with syptos. "eebulge.Balloon disc 5collo'uial, nonstandard6( )iffuse apparent enlargeent of the disc in superior-inferior e2tent because of bowing of the vertebral endplates due to wea%ening of the bone as in severe osteoporosis.Base (of displaced disc)( *he cross-sectional area of the disc aterial at the outer argin of the disc space of origin, where disc aterial beyond the disc space is continuous with disc aterial within the disc space. In the craniocaudal direction, thelength of the base cannot e2ceed, by definition, the height of the intervertebral space. ?n a2ial iaging, base refers to the width at the outer argin of the disc space, of the origin of any disc aterial e2tending beyond the disc space.Black disc 5collo'uial, nonstandard6( "ee dar% disc.Bulging disc, bulge (noun n!), bulge (verb v!)1. , disc in which the contour of the outer annulus e2tends, or appears to e2tend, in the hori&ontal 5a2ial6 plane beyond the edges of the disc space, usually greater than 20> 59@A6 of the circuference of the disc and usually less than Bbeyond the edges of the vertebral body apophysis.2. 5$onstandard6 , disc in which the outer argin e2tends over a broad base beyond the edges of the disc space.B. 5$onstandard6 Mild, diffuse, sooth displaceent of disc... 5$onstandard6 ,ny disc displaceent at the discal level.Note: Culging is an observation of the contour of the outer disc and is not a specific diagnosis. Culging has been variously ascribed to redundancy of the annulus, secondary to the loss of disc space height, ligaentous la2ity, response to loading or angular otion, reodeling in response to ad7acent pathology, unrecogni&ed and atypical herniation, and illusion fro volue averaging on ;* a2ial iages. Mild, syetric, posterior disc bulging ay be a noral finding at 30D"1. Culging ay or ay not represent pathological change, physiological variant, or noralcy. Culging isnot a for of herniation< discs %nown to be herniated should be diagnosed as herniation or, when appropriate, as specific types of herniation. "ee herniated disc, protruded disc, and e2truded disc."alcified disc( ;alcification within the disc space, not inclusive of osteophytes at the periphery of the disc space."avitation( "paces, cysts, clefts, or cavities fored within the nucleus and inner annulus fro disc degeneration. "ee vacuu disc."entral zone( 9one within the vertebral canal between sagittal planes through the edial edges of each facet. Note: *he center of the central &one is a sagittal plane through the center of the vertebral body. *he &ones to either side of the center planeare right central and left central, which are preferred ters when the side is %nown, as when reporting iaging results of a specific disc. Ehen the side is unspecified, orgrouped with both right and left represented, the ter paracentral is appropriate."hronic disc herniation( , clinical distinction that a disc herniation is of long duration.*here are no universally accepted definitions of the intervals that distinguish between acute, subacute, and chronic disc herniations. "erial MRIs revealing disc herniations that are unchanged in appearance over tie ay be characteri&ed as chronic. )isc herniations associated with calcification or gas on ;* ay be suggested as being chronic. =ven so, the presence of calcification or gas does not rule out an acutely herniated disc. $ote that an acute disc herniation ay be superiposed on a chronic disc herniation. MRI signal characteristics ay, on rare occasion, allow differentiation of acute and chronic disc herniations.-1/,09,/.1 In such cases, acutely herniated disc aterial ay appear brighter than the disc of origin on *2-weighted se'uences.-./,09,/11 ,lso, see disc-osteophyte cople2."la# osteophyte( Cony outgrowth arising very close to the disc argin, fro the vertebral body apophysis, directed, with a sweeping configuration, toward the corresponding part of the vertebral body opposite the disc."ollagenized disc or nucleus( , disc in which the ucopolysaccharide of the nucleushas been replaced by fibrous tissue."ommunicating disc, communication (n), communicate (v) 5nonstandard6( ;ounication refers to interruption in the periphery of the disc annulus, peritting free passage of fluid in7ected within the disc to the e2terior of the disc, as ay be observed during discography. $ot synonyous with 4uncontained.4 "ee contained disc and uncontained disc."oncentric fissure( :issure of the annulus characteri&ed by separation of annular fibers in a plane roughly parallel to the curve of the periphery of the disc, creating fluid-filled spaces between ad7acent annular laellae. "ee radial fissures, transversefissures, 8I9."ontained herniation, containment (n), contain (v)1. )isplaced disc tissue e2isting wholly within an outer perieter of uninterrupted outer annulus or posterior longitudinal ligaent.2. 5$onstandard6 , disc with its contents ostly, but not wholly, within annulus or capsule.B. 5$onstandard6 , disc with displaced eleents contained within any investiture of the vertebral canal., disc that is less than wholly contained by annulus, but under a distinct posterior longitudinal ligaent, is contained. )esignation as 4contained4 or 4uncontained4 defines the integrity of the ligaentous structures surrounding the disc, a distinction that is often but not always possible by advanced iaging. ?n ;* and MRI scans, contained herniations typically have a sooth argin whereas uncontained herniations ost often have irregular argins because the outer annulus and the posterior longitudinal ligaent have been penetrated by the disc aterial.-B0,BF1 ;*-discography also does not always allow one to distinguish whether the herniated coponents of a disc are contained but only whether there is counication between the disc space and the vertebral canal."ontinuity( ;onnection of displaced disc tissue by a bridge of disc tissue, however thin, to tissue within the disc of origin.$allas classification 5of postdiscography iaging6( ;oonly used grading syste for the degree of annular fissuring seen on ;* scan of discs after discography. )allas grade @ is noral< grade 1, lea%age of contrast into the inner one-third of the annulus< grade 2, lea%age of contrast into the inner two-thirds of the annulus< grade B, lea%age through the entire thic%ness of the annulus< grade ., contrast e2tends circuferentially< grade 0, contrast e2travasates into the epidural space. "ee discogra, discography.$ark disc 5collo'uial, nonstandard6( )isc with nucleus showing decreased signal intensity on *2-weighted iages 5dar%6, usually because of desiccation of the nucleus secondary to degeneration. ,lso blac% disc 5collo'uial, nonstandard6. "ee disc degeneration, #firrann classification.$egenerated disc, degeneration (n), degenerate (v)1. ;hanges in a disc characteri&ed to varying degrees by 1 or ore of the following( desiccation, cleft foration, fibrosis, and gaseous degradation of the nucleus< ucinous degradation, fissuring, and loss of integrity of the annulus< defects in and+or sclerosis of the endplates< and osteophytes at the vertebral apophyses.2. Iaging anifestation of such changes, including-B01 standard roentgenographical findings, such as disc space narrowing and peridiscal osteophytes, MRI disc findings 5see #firrann classification-/116, ;* disc findings 5see discogra+discography and )allasclassification-.216, and+or MRI findings of vertebral end plate and arrow reactive changesad7acent to a disc 5see Modic classification-B816.$egenerative disc disease 5nonstandard ter when used as an iaging description6( , condition characteri&ed by anifestations of disc degeneration and syptos thought to be related to those of degenerative changes. Note: ;ausal connections between degenerative changes and syptos are often difficult clinicaldistinctions. *he ter 4degenerative disc disease4 carries iplications of illness that ay not be appropriate if the only or priary indicators of illness are fro iaging studies and thus this ter should not be used when describing iaging findings. *hepreferred ter for description of iaging anifestations is 4degenerated disc4 or 4disc degeneration,4 rather than 4degenerative disc disease.4$elamination: "eparation of circuferential annular fibers along the planes parallel to the periphery of the disc, characteri&ing a concentric fissure of the annulus.$esiccated disc1. )isc with reduced water content, usually priarily of nuclear tissues.2. Iaging anifestations of reduced water content of the disc, such as decreased 5dar%6 signal intensity on *2-weighted iages, or of apparent reduced water content, as fro alterations in the concentration of hydrophilic glycosainoglycans. ,lso, see dar% disc 5collo'uial, nonstandard6.$isc (disk)( ;ople2 structure coposed of nucleus pulposus, annulus fibrosus, cartilaginous endplates, and vertebral body ring apophyseal attachents of annulus. Note: Most =nglish language publications use the spelling 4disc4 ore often than 4dis%.4-1,2@,22,/9,F@1Nomina Anatomica designates the structures as 4disci intervertebrales4 and Terminologia Anatomica as 4discus intervertebralis+intervertebral disc.4-22,F@1 "ee 4disc level4 for naing and nubering of a particular disc.$isc height( *he distance between the planes of the endplates of the vertebral bodies craniad and caudad to the disc. )isc height should be easured at the center of the disc and not at the periphery. If easured at the posterior or anterior argin of the disc on a sagittal iage of the spine, this should be clearly specified as such.$isc level( 3evel of the disc and vertebral canal between a2ial planes through the bony endplates of the vertebrae craniad and caudad to the disc being described.1. , particular disc is best naed by naing the region of the spine and the vertebra aboveand below it< for e2aple, the disc between the fourth and fifth lubar vertebral bodies isnaed 4lubar .D0,4 coonly abbreviated as 3.D30, and the disc between the fifth lubar vertebral body and the first sacral vertebral body is called 4lubosacral disc4 or 430D"1.4 ;oon anoalies include patients with / lubar vertebrae or transitional vertebrae at the lubosacral 7unction that re'uire, for clarity, narrative e2planation of the naing of the discs.2. 5$onstandard6 , disc is soeties labeled by the vertebral body above it< for e2aple, the disc between 3. and 30 ay be labeled 4the 3. disc.4B. Note: 4, otion segent,4 nubered in the sae way, is a functional unit of the spine, coprising the vertebral body above and below, the disc, the facet 7oints, and the connecting soft tissues and is ost often referenced with regard to the stability of the spine.$isc of origin( )isc fro which a displaced fragent originated. "ynony( parent disc. Note: Cecause displaced fragents often contain tissues other than nucleus, disc of origin is preferred to nucleus of origin. #arent disc is synonyous but ore collo'uial and nonpreferred.$isc space( "pace liited, craniad and caudad, by the endplates of the vertebrae and peripherally by the edges of the vertebral body ring apophyses, e2clusive of osteophytes. "ynony( intervertebral disc space. "ee 4disc level4 for naing and nubering of discs.$iscogenic vertebral sclerosis( Increased bone density and calcification ad7acent to the endplates of the vertebrae, craniad and caudad, to a degenerated disc, soeties associated with intervertebral osteochondrosis. Manifested on MRI as Modic type III.$iscogram, discography( , diagnostic procedure in which contrast aterial is in7ected into the nucleus of the disc with radiographical guidance and observation, often followed by ;*+discogra. *he procedure is often accopanied by pressure easureents and assessent of pain response 5provocative discography6. *he degree of annular fissuring identified by discography ay be defined by the )allas classification and its odifications. "ee )allas classification.$isc%osteophyte comple&( Intervertebral disc displaceent, whether bulge, protrusion, or e2trusion, associated with calcific ridges or ossification. "oeties called a hard disc or chronic disc herniation 5nonpreferred6. )istinction should be ade between 4spondylotic disc herniation,4 or 4calcified disc herniation4 5nonpreferred6, the renants of an old disc herniation, and 4spondylotic bulging disc,4 a broad-based bony ridge presuably related to chronic bulging disc.$isplaced disc 5nonstandard6( , disc in which disc aterial is beyond the outer edges of the vertebral body ring apophyses 5e2clusive of osteophytes6 of the craniadand caudad vertebrae or, as in the case of intravertebral herniation, has penetrated through the vertebral body endplate.Note: 4)isplaced disc4 is a general ter that does not iply %nowledge of the underlying pathology, cause, relationship to syptos, or need for treatent. *he ter includes, but is not liited to, disc herniation and disc igration. "ee herniated disc, igrated disc.'pidural membrane( "ee peridural ebrane.'&traforaminal zone( *he peridiscal &one beyond the sagittal plane of the lateral edges of the pedicles, having no well-defined lateral border, but definitely posterior to the anterior &one. "ynony( 4far lateral &one,4 also 4far-out &one4 5nonstandard6.'&traligamentous( #osterior or lateral to the posterior longitudinal ligaent. Note: =2traligaentous disc refers to displaced disc tissue that is located posterior or lateral to the posterior longitudinal ligaent. If the disc has e2truded through the posterior longitudinal ligaent, it is soeties called 4transligaentous4or 4perforated4 and if through the peridural ebrane, it is soeties refined to 4transebranous.4'&truded disc, e&trusion (n), e&trude (v)( , herniated disc in which, in at least one plane, any one distance between the edges of the disc aterial beyond the disc space is greater than the distance between the edges of the base of the disc aterial beyond the disc space in the sae plane or when no continuity e2ists between the disc aterial beyond the disc space and that within the disc space.Note: *he preferred definition is consistent with the coon iage of e2trusion, as an e2pulsion of aterial fro a container through and beyond an aperture. )isplaceent beyond the outer annulus of the disc aterial with any distance between its edges greater than the distance between the edges of the basedistinguishes e2trusion fro protrusion. )istinguishing e2trusion fro protrusion by iaging is best done by easuring the edges of the displaced aterial and the reaining continuity with the disc of origin, whereas relationship of the displaced portion to the aperture through which it has passed is ore readily observed surgically. ;haracteristics of protrusion and e2trusion ay coe2ist, in which case thedisc should be subcategori&ed as e2truded. =2truded discs in which all continuity with the disc of origin is lost ay be further characteri&ed as 4se'uestrated.4 )isc aterial displaced away fro the site of e2trusion ay be characteri&ed as 4igrated.4 "ee herniated disc, igrated disc, protruded disc.Note: ,n alternative schee is espoused by soe respected radiologists who thought that it has better clinical application. *his schee defines e2truded disc as synonyous with 4uncontained disc4 and does not use coparative easureents of the base versus the displaced aterial. #er this definition, a disc e2trusion can beidentified by the presence of a continuous line of low signal intensity surrounding thedisc herniation. :uture study will further deterine the validity of this alternative definition. "ee contained disc.(ar lateral zone( *he peridiscal &one beyond the sagittal plane of the lateral edge of the pedicle, having no well-defined lateral border, but definitely posterior to the anterior &one. "ynony( 4e2traforainal &one.4(issure of annulus( "ee annular fissure.(oraminal zone( *he &one between planes passing through the edial and lateral edges of the pedicles. Note: *he forainal &one is soeties called the 4pedicle &one4 5nonstandard6, which can be confusing because pedicle &one ight also refer to easureents in the sagittal plane between the upper and lower surfaces of a given pedicle that is properly called the 4pedicle level.4 *he forainal &one is also soeties called the 4lateral &one4 5nonstandard6, which can be confusing because the 4lateral &one4 can be confused with 4lateral recess4 5subarticular &one6 and can also ean e2traforainal &one or an area including both the forainal and e2traforainal &ones.(ree fragment1. , fragent of disc that has separated fro the disc of origin and has no continuous bridge of disc tissue with disc tissue within the disc of origin. "ynony( se'uestrated disc.2. 5$onstandard6 , fragent that is not contained within the outer perieter of the annulus.B. 5$onstandard6 , fragent that is not contained within the annulus, posterior longitudinal ligaent, or peridural ebrane.Note: 4"e'uestrated disc4 and 4free fragent4 are virtually synonyous. Ehen referring to the condition of the disc, categori&ation as e2truded with subcategori&ation as se'uestrated is preferred, whereas when referring specifically to the fragent, free fragent is preferred.)ap of annulus( "ee annular gap.*ard disc 5collo'uial6( )isc displaceent in which the displaced portion has undergone calcification or ossification and ay be intiately associated with apophyseal osteophytes. Note: *he ter 4hard disc4 is ost often used in reference to the cervical spine to distinguish chronic hypertrophic and reactive changes at the periphery of the disc fro the ore acute e2trusion of soft, predoinantly nuclear tissue. "ee chronic disc herniation, disc-osteophyte cople2.*erniated disc, herniation (n), herniated (v)( 3ocali&ed or focal displaceent of disc aterial beyond the noral argin of the intervertebral disc space. Note: 43ocali&ed4 or 4focal4 eans, by way of convention, less than 20> 59@A6 of the circuference of the disc.8erniated disc aterial ay include nucleus pulposus, cartilage, fragented apophyseal bone, or annulus fibrosus tissue. *he noral argins of the intervertebral disc space are defined, craniad and caudad, by the vertebral body endplates and peripherally by the edges of the vertebral body ring apophyses, e2clusive of osteophytic forations. 8erniated disc generally refers to displaceent of disc tissues through a disruption in the annulus, the e2ception being intravertebralherniations 5"chorl nodes6 in which the displaceent is through the vertebral endplate. 8erniated discs ay be further subcategori&ed as protruded or e2truded. 8erniated disc is soeties referred to as herniated nucleus pulposus, but the ter 4herniated disc4 is preferred because displaced disc tissues often include cartilage, bone fragents, or annular tissues. *he ters 4prolapse4 and 4rupture4 when referring to disc herniations are nonstandard and their use should be discontinued. Note: 48erniated disc4 is a ter that does not iply %nowledge of the underlying pathology, cause, relationship to syptos, or need for treatent.*erniated nucleus pulposus 5nonpreferred6( "ee herniated disc.*igh%intensity zone( ,rea of high intensity on *2-weighted MRIs of the disc, located coonly in the outer annulus. Note: 8I9s within the posterior annular substance ay indicate the presence of an annular fissure within the annulus, but these ters are not synonyous. ,n 8I9 itself ay represent the actual annular fissure or, alternatively, ay represent vasculari&ed fibrous tissue 5granulation tissue6 within the substance of the disc in an area ad7acent to a fissure. *he visuali&ation of an 8I9does not iply a trauatic etiology or that the disc is a source of pain.+nfrapedicular level( *he level between the a2ial planes of the inferior edges of the pedicles craniad to the disc in 'uestion and the inferior endplate of the vertebral body above the disc in 'uestion. "ynony( superior vertebral notch.+nternal disc disruption( )isorgani&ation of structures within the disc. "ee intra-annular displaceent.+nterspace( "ee disc space.+ntervertebral chondrosis( "ee intervertebral osteochondrosis.+ntervertebral disc( "ee disc.+ntervertebral disc space( "ee disc space.+ntervertebral osteochondrosis( )egenerative process of the disc and vertebral body endplates that is characteri&ed by disc space narrowing, vacuu phenoenon, and vertebral body reactive changes. "ynony( osteochondrosis 5nonstandard6.+ntra%annular displacement( )isplaceent of central, predoinantly nuclear, tissue to a ore peripheral site within the disc space, usually into a fissure in the annulus. "ynony( intra-annular herniation 5nonstandard6, intradiscal herniation. Note: Intra-annular displaceent is distinguished fro disc herniation, that is, herniation of disc refers to displaceent of disc tissues beyond the disc space. Intra-annular displaceent is a for of internal disruption. Ehen referring to intra-annular displaceent, it is best not to use the ter 4herniation4 to avoid confusion with disc herniation.+ntra%annular herniation 5nonstandard6( "ee intra-annular displaceent.+ntradiscal herniation 5nonstandard6( "ee intra-annular displaceent.+ntradural herniation( )isc aterial that has penetrated the dura so that it lies in an intradural e2traedullary location.+ntravertebral herniation( , disc displaceent in which a portion of the disc pro7ects through the vertebral endplate into the centru of the vertebral body. "ynony( "chorl node.,ateral recess( *he portion of the subarticular &one that is edial to the edial border of the pedicle. It refers to the entire cephalad-caudad region that e2ists edial to the pedicle, where the sae nubered thoracic or lubar nerve root travels caudally before e2iting the nerve root foraen under the caudal argin of thepedicle. It does not refer to the nerve root foraen itself. ,lso, see subarticular &one.,ateral zone 5nonstandard6( "ee forainal &one.,eaking disc 5nonstandard6( "ee counicating disc.,imbus vertebra( "eparation of a segent of vertebral ring apophysis. Note: 3ibus vertebra ay be a developental abnorality caused by failure of integration of the ossifying apophysis to the vertebral body< a chronic herniation 5e2trusion6 of the discinto the vertebral body at the 7unction of the fusing apophyseal ring, with separation of a portion of the ring with bony displaceent< or a fracture through the apophyseal ring associated with intrabody disc herniation. *his occurs in children before the apophyseal ring fuses to the vertebral body. In adults, a libus vertebra should not be confused with an acute fracture. , libus vertebra does not iply that there has been an in7ury to the disc or the ad7acent apophyseal endplate.-arginal osteophyte( ?steophyte that protrudes fro and beyond the outer perieter of the vertebral endplate apophysis.-arro# changes (of vertebral body)( "ee Modic classification.-igrated disc, migration (n), migrate (v)1. 8erniated disc in which a portion of the e2truded disc aterial is displaced away fro the fissure in the outer annulus through which it has e2truded in either the sagittal or a2ial plane.2. 5$onstandard6 , herniated disc with a free fragent or se'uestru beyond the disc level.Note: Migration refers to the position of the displaced disc aterial, rather than to its continuity with disc tissue within the disc of origin< therefore, it is not synonyous with se'uestration.-odic classification (types +, ++, and +++)(-B@1 , classification of degenerative changes involving the vertebral endplates and ad7acent vertebral bodies associated with disc inflaation and degenerative disc disease, as seen on MRIs. *ype I refers to decreased signal intensity on *1-weighted spin-echo iages and increased signal intensity on *2-weighted iages, representing penetration of the endplate by fibrovascular tissue, inflaatory changes, and perhaps edea. *ype I changes ay be chronic or acute. *ype II refers to increased signal intensity on *1-weighted iages and isointense or increased signal intensity on *2-weighted iages, indicating replaceent of noral bone arrow by fat. *ype III refers to decreased signal intensity on both *1- and *2-weighted iages, indicating reactive osteosclerosis. "ee discogenic vertebral sclerosis.-otion segment( *he functional unit of the spine. "ee disc level.Nonmarginal osteophyte( ,n osteophyte that occurs at sites other than the vertebral endplate apophysis. "ee arginal osteophyte.Normal disc( , fully and norally developed disc with no changes attributable to traua, disease, degeneration, or aging. Note: Many congenital and developental variations ay be clinically noral, that is, they are not associated with syptos, and certain adaptive changes in the disc ay be noral considering ad7acent pathology< however, classification and reporting for edical purposes are best served if such discs are not considered noral. $ote, however, that a disc finding considered not noral does not necessarily iply a cause for clinical signs or syptoatology< the description of any variation of the disc is independent of clinical7udgent regarding what is noral for a given patient.Nucleus of origin 5nonpreferred6( *he central, nuclear portion of the disc of reference, usually used to reference the disc fro which the tissue has been displaced. Note: Cecause displaced fragents often contain tissues other than the nucleus, disc of origin is preferred to nucleus of origin. "ynony( disc of origin 5preferred6, parent nucleus 5nonpreferred6..steochondrosis( "ee intervertebral osteochondrosis..steophyte( :ocal hypertrophy of the bone surface and+or ossification of the soft-tissue attachent to the bone./aracentral( In the right or left central &one of the vertebral canal. "ee central &one. Note: *he ters 4right central4 and 4left central4 are preferable when spea%ing of a single site if the side can be specified, as when reporting the findings of iagingprocedures. 4#aracentral4 is appropriate if the side is not significant or when spea%ing of i2ed sites./arent disc 5nonpreferred6( "ee disc of origin./arent nucleus 5nonpreferred6( "ee nucleus of origin, disc of origin./edicular level( *he space between the a2ial planes through the upper and lower edges of the pedicle.Note: *he pedicular level ay be further designated with reference to the disc in 'uestion as 4pedicular level above4 or 4pedicular level below4the disc in 'uestion./erforated 5nonstandard6( "ee transligaentous./eridural membrane( , delicate, translucent ebrane that attaches to the undersurface of the deep layer of the posterior longitudinal ligaent and e2tends laterally and posteriorly, encircling the bony spinal canal outside the dura. *he veins of Catson ple2us lie on the dorsal surface of the peridural ebrane and pierce it ventrally. "ynony( lateral ebrane, epidural ebrane./firrmann classification( , grading syste for the severity of degenerative changes within the nucleus of the intervertebral disc. , #firrann grade I disc has a unifor high signal intensity in the nucleus on *2-weighted MRI scans< grade II shows a central hori&ontal line of low signal intensity on sagittal iages< grade III shows high signal intensity in the central part of the nucleus, with lower intensity in the peripheral regions of the nucleus< grade IG shows low signal intensity centrally and blurring of the distinction between the nucleus and the annulus< and grade G shows hoogeneous low signal intensity, with no distinction between the nucleus and the annulus.-/11/rolapsed disc, prolapse (n, v) 5nonstandard6( *he ter is variously used to refer to herniated discs. Its use is not standardi&ed and the ter does not add to the precision of disc description, so it is regarded as nonstandard in deference to 4protrusion4 or 4e2trusion.4/rotruded disc, protrusion (n), protrude (v)1. ?ne of the 2 subcategories of a 4herniated disc4 5the other being an 4e2truded disc46 in which disc tissue e2tends beyond the argin of the disc space, involving less than 20> of the circuference of the disc argin as viewed in the a2ial plane. *he test of protrusion is that there ust be locali&ed 5H20> of the circuference of the disc6 displaceent of disc tissue and the distance between the corresponding edges of the displaced portion ust not be greater than the distance between the edges of the base of the displaced disc aterial at the disc space of origin. "ee base of displaced disc. ,lthough soeties used as a general ter in the way herniation is defined, the use of the ter 4protrusion4 is best reserved for subcategori&ation of herniation eeting the aforeentioned criteria.2. 5$onstandard6 ,ny or unspecified type of disc herniation.0adial fissure( )isruption of annular fibers e2tending fro the nucleus outward toward the periphery of the annulus, usually in the craniocaudal 5vertical6 plane, although, at ties, with a2ial hori&ontal 5transverse6 coponents. 4:issure4 is the preferred ter to the nonstandard ter 4tear.4 $either ter iplies %nowledge of in7ury or other etiology. Note: ?ccasionally, a radial fissure e2tends in the transverse plane to include an avulsion of the outer layers of the annulus fro the apophyseal ring. "ee concentric fissures, transverse fissures.0im lesion 5nonstandard6( "ee libus vertebra.0upture of annulus, ruptured annulus( "ee annular rupture.0uptured disc, rupture 5nonstandard6( , herniated disc. *he ter 4ruptured disc4 is an iproper synony for herniated disc, not to be confused with violent disruption ofthe annulus related to in7ury. Its use should be discontinued.1chmorl node( "ee intravertebral herniation.1e2uestrated disc, se2uestration (n), se2uestrate (v) 5variant( se2uestered disc6( ,n e2truded disc in which a portion of the disc tissue is displaced beyond the outer annulus and aintains no connection by disc tissue with the disc of origin. Note: ,n e2truded disc ay be subcategori&ed as 4se'uestrated4 if no disc tissue bridges the displaced portion and the tissues of the disc of origin. If even a tenuous connection by disc tissue reains between a displaced fragent and disc of origin, the disc is not se'uestrated. If a displaced fragent has no connection with the disc of origin, but is contained within peridural ebrane or under a portion of posterior longitudinal ligaent that is not intiately bound with the annulus of origin, the disc is considered se'uestrated. "e'uestrated and se'uestered are used interchangeably. Note: 4"e'uestrated disc4 and 4free fragent4 are virtually synonyous. "ee free fragent. Ehen referring to the condition of the disc, categori&ation as e2truded with subcategori&ation as se'uestered is preferred, whereas when referring specifically to the fragent, free fragent is preferred. "ee se'uestru.1e2uestrum 5nonpreferred6( Refers to disc tissue that has displaced fro the disc space of origin and lac%s any continuity with disc aterial within the disc space of origin. "ynony( free fragent 5preferred6. "ee se'uestrated disc. Note( 4"e'uestru4 5nonpreferred6 refers to the isolated free fragent itself, whereas se'uestrated disc defines the condition of the disc.1pondylitis( Inflaatory disease of the spine, other than degenerative disease. Note: "pondylitis usually refers to noninfectious inflaatory spondyloarthropathies.1pondylosis(1. ;oon nonspecific ter used to describe effects generally ascribed to degenerative changes in the spine, particularly those involving hypertrophic changes to the apophyseal endplates and &ygapophyseal 7oints.2. 5$onstandard6 "pondylosis deforans, for which spondylosis is a shortened for.1pondylosis deformans( )egenerative process of the spine involving the annulus fibrosus and vertebral body apophysis, characteri&ed by anterior and lateral arginal osteophytes arising fro the vertebral body apophyses, whereas the intervertebral disc height is noral or only slightly decreased. "ee degeneration, spondylosis.1ubarticular zone( *he &one, within the vertebral canal, sagittally between the plane of the edial edges of the pedicles and the plane of the edial edges of the facets and coronally between the planes of the posterior surfaces of the vertebral bodies and the anterior surfaces of the superior facets. Note:*he subarticular &one cannot be precisely delineated in 2-diensional depictions because the structures that define the planes of the &one are irregular. *he lateral recess is that portion of the subarticular &one defined by the edial wall of the pedicle where the sae nubered nerve root traverses before turning under the inferior wall of the pedicle into the foraen.1ubligamentous( Ceneath the posterior longitudinal ligaent. Note: ,lthough the distinction between outer annulus and posterior longitudinal ligaent ay not always be identifiable, subligaentous has eaning distinct fro subannular when the distinction can be ade. Ehen the distinction cannot be ade, subligaentous is appropriate. "ubligaentous contrasts to e2traligaentous, transligaentous, or perforated. "ee e2traligaentous, transligaentous.1ubmembranous( =nclosed within the peridural ebrane. Note: Eith reference to the displaced disc aterial, characteri&ation of a herniation as subebranous usually infers that the displaced portion is e2truded beyond the annulus and posterior longitudinal ligaent so that only the peridural ebrane invests it.1uprapedicular level( *he level within the vertebral canal between the a2ial planes ofthe superior endplate of the vertebra caudad to the disc space in 'uestion and the superior argin of the pedicle of that vertebra. "ynony( inferior vertebral notch.1yndesmophytes( *hin and vertically oriented bony outgrowths e2tending fro one vertebral body to the ne2t and representing ossification within the outer portion of the annulus fibrosus.Tear of annulus, torn annulus 5nonstandard6( "ee annular tear.Thompson classification: , 0-point grading scale of degenerative changes in the huan intervertebral disc, fro @ 5noral6 to 0 5severe degeneration6, based on gross pathological orphology of idsagittal sections of the lubar spine.Traction osteophytes( Cony outgrowth arising fro the vertebral body apophysis, 2 to Babove or below the edge of the intervertebral disc, pro7ecting in a hori&ontaldirection.Transligamentous( )isplaceent, usually e2trusion, of disc aterial through the posterior longitudinal ligaent. "ynony( perforated 5nonstandard6. ,lso, see e2traligaentous, transebranous.Transmembranous( )isplaceent of e2truded disc aterial through the peridural ebrane.Transverse fissure( :issure of the annulus in the a2ial 5hori&ontal6 plane. Ehen referring to a large fissure in the a2ial plane, the ter is synonyous with a hori&ontally oriented radial fissure. ?ften 4transverse fissure4 refers to a ore liited, peripheral separation of annular fibers including attachents to the apophysis. *hese ore narrowly defined peripheral fissures ay contain gas visible on radiographs or ;* scans and ay represent early anifestations of spondylosis deforans. "ee annular fissure, concentric fissure, radial fissure.3ncontained disc( )isplaced disc aterial that is not contained by the outer annulus and+or posterior longitudinal ligaent. "ee discussion under contained disc.4acuum disc( , disc with iaging findings characteristic of gas 5predoinantly nitrogen6 in the disc space, usually a anifestation of disc degeneration.4ertebral body marro# changes( Reactive vertebral body signal changes associatedwith disc inflaation and disc degeneration, as seen on MRIs. "ee Modic classification.4ertebral notch (inferior)( Incisura of the upper surface of the pedicle corresponding to the lower part of the foraen 5suprapedicular level6.4ertebral notch (superior)( Incisura of the under surface of the pedicle correspondingto the upper part of the foraen 5infrapedicular level6.HIZs were defned as a bright white signal located in the sbstance o! the posterior annls fbrosis" clearly dissociated !ro# the signal o! the ncles plposs in that it was srronded by the low$intensity (blac%) signal o! the annls fbross and was appreciably brighter than that o!the ncles plposs on T2$weighted sagittal M& i#agesHistory and Physical Exam, nurse or other healthcare professional conducts the initial interview. ,ll of your 'uestions and concerns should be addressed and answered. *his is the tie to relate any and all horror stories youay have heard fro edical 5and non-edical6 e2perts. )espite what youIve been told, the discogra is not designed to create agony.$e2t, the discographer will tal% with you to review the relevant anatoy and discuss the procedure inuch greater detail. Jou now have a second chance to as% 'uestions or decide whether or not to proceed.Initial Preparation for the Discogram ProcedureIf you agree to allow the discographer to perfor this e2a, an intravenous line is started 7ust in caseintra-procedural edications becoe necessary. Ksually, sedation is avoided so as not to interfere with any reactions or sensations you ay e2perience.,rticle continues belowIn This Article: um!ar Discography for "ac# Pain Diagnosis um!ar Discogram Procedure Discography $ideo: %on&'urgical "ac# Pain Diagnostic Procedure $e2t, you are placed on a speciali&ed table around which a fluoroscopic 52-ray6 unit is positioned. Jour bac% is then ar%ed with an in% pen over the disc spaces that will ultiately be e2ained. *henyour bac% is thoroughly cleansed and sterile drapes are applied. *he fluoroscope will also be sterilelydraped and the discographer will be in a sterile surgical gown. Administration of ocal Anesthesia *he goal is to anestheti&e a core of tissue that e2tends fro your s%in to the disc surface. Ehen these tissues are nubed a guide needle is directed towards the disc and will 7ust touch the outer surface of the annulus 5the outer argin of the disc6. More Back Pain Info (auses of %ec#)"ac# Pain "ac# Pain and (ancer 'pondylosis Information "ac# and %ec# 'urgery "ac# Pain and Exercise *hrough this guide needle a uch saller disc needle is advanced towards and eventually into the center of the disc. *his process should not be painful, but soeties ay be. *he discogra procedure usually ta%es less than an hour to perfor. JouIll have soreness fro the needle punctures that lasts several days. Jou ay use acetainophen, ibuprofen or apply an ice pac% for a few inutes to ease the soreness. "oe physicians prescribe short ter narcotic pain edications for use after the procedure. Pressuri*ing the Discs & the Diagnostic Portion of the Discogram Procedure ,fter all of the needles are placed, the discs are 4pressuri&ed4 one at a tie. #ressuri&ation consists of in7ecting sall aounts of a sterile li'uid 5usually contrast aterial 52-ray dye66 into the center of the disc. *his is the ost iportant part of the study and you ust concentrate on what you are feeling. *hereare essentially three choices( 1. Jou feel nothing 2. Jou feel pressure B. Jou feel pain If you feel pain fro the in7ection, the pain is either( +amiliar pain, which translates into 4ouch, thatIs y painL4 -nfamiliar pain, which belongs to soeone else or translates into 4ouch, IIve never felt that pain before.4 ,fter each level is pressuri&ed, pictures are ta%en with the fluoroscopic unit and the needles are reoved. Ksually, a post-discogra ;* is obtained to docuent the internal architecture of the disc. ,nd thatIs itL *he procedure usually ta%es less than an hour to perfor. JouIll have soreness fro the needle punctures that lasts several days. Jou ay use acetainophen, ibuprofen or apply an ice pac% for a few inutes to ease the soreness. Possi!le .is#s and (omplications of a Discogram ,s with any other invasive test, there are associated ris%s and possible coplications. *he ost feared coplication is a disc space infection, which can be very difficult to treat. :ortunately, by using very strict sterile techni'ues this is a very uncoon coplication. *here are e2treely reote possibilities of nerve root in7ury "pinal headache is also a reote ris% Eith a s%illed and e2perienced discographer who uses odern discography techni'ues, all of these ris%s are very rare. In suary, a discogra is a preoperative study designed to deterine if an intervertebral disc is a pain generator. *he initial needle placeent need not be painful. If pressuri&ation of a disc causes a failiar pain, then surgical obliteration 5fusion6 of the pain generator5s6 ay afford significant !ac# pain relief.