Anatomy of disk normal adult

• Twoo Elements :
- Nucleus pulposus
- Ring lamellenx
• Thickness increase of L1-L2 to L4-L5

• Form: identical Vertebral plateau who insert

 Nucleux pulposus:

- Ovoid form, and homogeneous gelatinous

- Central location
- Volume: 1/3 on 1/4 of volume Lumbar disc.
Lamelleux ring or annulus:
- Made up of fibrous strips concentric
- Slides from 200 to 400 microns in diameter
- Oblique direction Increases elasticity of
the disc
- Insertion into the vertebral plates
. Deeply anterior and laterally
. posterior the insertion of the fibre is the
least resistant (headquarters discal
hernia).
 Vertebral plateau :

Constitutes a central cartilage plate and a

periphery crescent bone : the listel marginal.
Plateau vertebrale: Bourelet marginal (3)
plaque cartilagineuse (4)
Vascularisation and innervation:

- Avscular

- Posterior part innerved superficially by the

sinu-vertebrale nerve
 Anatomical reports :
Commun longitudinal ligaments (C. L.L.)

1) Anterior C. L.L.

Band fibrous heavily inserted

on the anterior and lateral face of the
vertebral body except at the Listel.
( a virtual space inter-disco-marginal
ligament. Instead of osteophyts)
 2) Posterior C. L.L.

- Vertical fiber
- Large at the level of the disk,
narrow at the level of the vertebral body
- Adheres to the posterior face of the disc.

- Pass a bridge back to the nourished hole

of vertebral body.
 Histology:

Inter-vertebral disc contains few cells

. Chondrocytes
. Fibrocytes
Matrix extra-cellular
. Fibers collagens type 2 (nucleus)
. Fibers collagens type 1 (annulus)
. Fibers elastic.
 Biochemistry disc:
Collagen and proteoplycans gel

Collagen:
. 50% of the dry weight of the disc
. 3 × more abundant in the annulus than
the nucleus
- smaller at the zone postero-lateral (headquarters
disc hernia)
. It doesn’t almost synthesizes in adult :
Turn- over several hundred years
 Proteoglycans (P.G.)

- 50% of the dry weight of the nucleus,

- 10% of the dry weight of the annulus

- Protein axis (acid hyalurinique) on which set of linear

side chains of sulfur disaccharides:
( glycosaminoglycans :G.A.G).

P.G. can absorb dozens of times their

weight in water
 GlycosAminoGlycans :G.A.G.
Chains disaccharides sulfur load negative:

 Keratan sulfate (ks) and the

 Chondroitin sulfate (cs):

 large hydrophilic disc)

More concentration G.A.G. will pupil, the

more internal tension disc will be great.
.
 water
Essential constituting :

65 to 90% of the volume tissue

(88% nucleus, annulus 78%)
 Ions:

lots of cations (sodium + +) and less

anion than the neighbors tissues.
(as a result of the negative charge of P.G.)
Fat
 Nutrition disc
By diffusion (movement of water
leaving and entering on the disc)
Essentiellement avec les vaisseaux
péridiscaux,
 Principalement à travers la PCV
 the central part of the vertebral plates.
Accessoirement avec les plexus
vasculaires à la périphérie de l'AF
 Nutrition
• Dépend de l'intégrité de la PCV: (Trauma
décollement  dégénérescence discale).

• Dépend de l'état de la vascularisation

intrinsèque :
(vieillissement  état circulatoire précaire 
dégénérescence discale).
 Ageing disc

Starting from 30 years:

- NUCLEUS is gradually losing its turgescent,
gelatinous, elastic to become more fibrous
- The content in water decreases
- Decrease the hydrophilic of nucleus.
(decrease in proteoglycans and their deterioration)

At 60 years:
loss of property mechanical lumbar disc
l'inflammation et le Stress mécanique:

Jouent un rôle majeur dans la

régulation de la dégénérescence discale,
 Dégénérescence discale et
stress mécanique

l'intégrité de la matrice extracellulaire est

le résultat d'un équilibre entre synthèse et
dégradation des protéines matricielles (PG
et collagènes)
 Contraintes en compression

Contraintes supraphysiologique
 Inhibe la synthèse de PG
Contraintes physiologique:
 stimule la synthèse de PG
 Contraintes en traction:

 Ne modulent pas la synthèse de PG

par le NP
 Diminuent la synthèse de PG par l'AF.
Les réponses métaboliques du DIV semblent
donc :
Tissu – stimulus - dépendantes.
Dual role of the nucleus pulposus:

1) Excellent dispatcher pressures:

Hydrostatic model: he returned the
pressures it receives evenly, centrifugal
force on its entire surface
 2) Setting state of prestressing
of the annulus:

The internal pressure of the nucleus ,

inside the disk is an equilibrate with the
resistance to distention the ring lamellae
Role of the ring lamelleux
1) A extremely strong means union
between two vertebrates adjacent

2) Effective damper charges

 Physiological role of the disc.

1 - vertebral stability
2 - spinal stability
3 - spinal mobility :

- Flexion-extension
- Rotation.
- Inclination.
The disc damper charge:
- This depreciation of the charges on the disc is

a compression-distension
- Under the effect of the load the disc tends to
collapse and laterally bomber
- A normal disc can supports an axial
charges : 400-500 kg
Other systems of damper charges:
1) Posterior articular apophysis :
> When the person inclines forward, the articular
facet joints becomes almost horizontal and
bearing and can support 10 to 20% of the load

2) The caisson thoraco-abdominal:

- Hydro- pneumatic damper mounted on parallel
to the spine
- Absorbs 20% of the charges imposed on the
lumbar spine.
 when walking

 Succession of compression and

relaxation of the ring lamellae
 Incessant change of the form of the
disk starts a phenomenon pump
favorable for the imbibitions of the disc,
best preserved that prolonged standing.

Walking fatigue least, the disk ,still the

standing.