Internal disc disruption

1. What is an internal disc disruption?
2. How are internal disc disruptions graded?
3. What is the cause?
4. What is the clinical presentation?
5. What diagnostic studies are used?
6. What is the treatment of internal disc disruption?

Answers:
1. Degradation of the internal disc without gross herniation, resulting in fissures and erosion of the annulus.
2. Grade 0: normal. Grade 1: inner 1/3 disruption. Grade 2: inner 2/3 disruption. Grade 3: outer 1/3 disruption.
3. Endplate fractures from excessive load.
4. Constant aching axial discomfort, worse with stress.
5. CT/discogram (for radial fissures), MRI (shows high intensity zone in annulus).
6. Conservative care includes relative rest, rehab, ESI. Spinal procedures for unremitting pain.