FACT: Disc pain is the cause of chronic pain and permanent impairment in many cases-even without herniation or nerve impingement.
The outer wall of the disc (anulus) can be torn by whiplash trauma, i.e. an annular tear. That tear produces pain coming from the nerve endings in the annulus. That occurs without any nerve impingement.
The NASS says,
“The disc is the major cause of chronic neck pain in about 25% of patients…”
Many peer-reviewed medical articles have confirmed that disc pain is the cause of chronic pain-even where there is no actual nerve impingement. (Jinkens, Freemont)
Annular Fissures (Tears)
- Radial Annular Fissures are a tearing which begins within the center of the disc (nucleus pulposus) and progresses outward in a radial direction. Radial fissures are commonly associated with a single distinct trauma.
- Circumferential Annular (Concentric) Fissures are a separation or splitting apart of the annulus fibrosis, between the lamellae rings. Usually repetitive micro trauma on the annulus is the cause of circumferential fissures.
- The term bulging refers to the extension of disc borders beyond the apophyses.
- A bulging occurs in greater than 50% of the disc circumference and usually extends a short distance usually less than 3mm.
- Bulging occurs as a result of a normal variant, advanced disc degeneration, vertebral body remodeling, or adjacent structural deformities such as scoliosis or spondylolithesis.
- Disc bulging can be either symmetrical or asymmetrical.
- Disc bulging is degenerative but has been identified six months to one year post trauma along with osteophyte development.
Focal vs. Broad-Based Disc Protrusions
- Disc Protrusions may be focal or broad-based. The distinction between the two is arbitrarily set at 25% of the circumference of the disc.
- Protrusions with a base less than 25% (90 degrees) of the circumference of the disc are “focal”.
- Protrusions encompassing 25% to 50% of the circumference of the disc is considered “broad-based”.