Thoracolumbar Spine Anatomy and Pathology - Degenerated L3 L4 Disc

Severely Degenerated L3 L4 Disc of a 70 year old male

Axial section through a severely degenerated L3-L4 disc of a 70-year old man
Axial section through a severely degenerated L3–L4 disc of a 70–year–old man who had presented with a history of low back pain and several episodes of transient radicular pain in his forties. The facet joints are markedly degenerated and display advanced reactive hypertrophic changes, rendering the facet joints a ball–and–socket configuration. This joint hypertrophy narrows the spinal canal from side to side, but it also severely encroaches on the neuroforamina which are practically obliterated by the intrusion of the superior articular processes from below (this phenomenon is well illustrated in sagittal SLIDE 19). Note also the ectopic bone fragment in the ligamentam flavum insertion site to the left (enthesopathy = ligament insertion site ossification). The discs bulges circumferentially and markedly contributes to foramen obliteration and encroachment on the spinal canal anteriorly. On both sides of the midline, old defects of the disc are now invaded by pink–colored granulation tissue which in turn is surrounded by white metaplastic disc matrix. The granulation tissue is probably the result of "neovascularization" of the disc from the epidural space through clefts or defects in the outer annulus fibrosus. Neovascularization tissue is highly vascular and cellular (fibroblasts) and therefore gives rise to signal changes on MR, especially after Gadolinium contrast enhancement.


©2000 Wolfgang Rauschning, M.D., Ph.D.
Professor of Clinical Anatomy
Academic University Hospital
Department of Orthopaedic Surgery
Uppsala, Sweden
Reproduction without permission is prohibited

Updated on: 11/02/16

Get new patient cases delivered to your inbox

Sign up for our healthcare professional eNewsletter, SpineMonitor.
Sign Up!