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Anatomy and pathophysiology of intervertebral disc disease
Techniques in Regional Anesthesia and Pain Management, 08/26/09

Shankar H et al. – Various therapeutic modalities have been attempted with minimal long–term success to alleviate the poorly described disc–related pain. To better understand the pain originating from the disc, this article attempts to explore the anatomy of the disc and the different perturbations that occur following aging and degeneration. There is a great deal of similarity among the discs in different levels. They all consist of a nucleus pulposus, surrounded by the annulus fibrosus, whose outer layers integrate with the endplate and the ligaments to strengthen and provide support. The spinal arteries provide the nutrient supply, and the lack thereof seems to be a hallmark of degeneration and aging. The nerve supply is provided by the sympathetic chain and from the recurrent sino vertebral nerve, but only the outermost layers of the annulus contain the sensory nerve fibers. There also appears to be some genetic variation in the rate and degree of synthesis and breakdown in the primary structural components of the disc, increasing the predisposition for disc–related pain.

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