The intervertebral disc, which has many functions, is subjected to a

considerable variety of forces and moments. Along with the facet

joints, it is responsi before carrying all the compressive loading to
which the trunk is subjected.'oo. ,., When a person is stand ing
erect, the forces to which a disc is subjected are much greater than
the weight of the portion of the body above it. In fact, Nachemson
and his associates have determined that the force on a lumbar disc
in a sitting position is more than three times the weight of the trunk
A161.165 Such large loads have also been
predicted by mathematical models."'227 In addi tion, with any
activity where dynamic loads are involved (e.g., jumping and
trauma), the actual loads on the intervertebral disc are much higher,
perhaps up to twice as high as those in the static positions. These
are mainly compressive loads. The disc is also subjected to other
types of loads and stresses. Ten sile stresses are produced in certain
portions of the disc during physiologic motions of flexion, exten sion,
and lateral bending. Axial rotation of the torso with respect to the
pelvis causes torsional loads that result in shear stresses in the
lumbar discs. Com bined rotation and bending result in stresses in
the disc that are a combination of tensile, compressive,
and shear stresses.
The loads to which the disc is subjected may be divided into two
main categories according to the duration of application: short
duration-high ampli tude loads (e.g., jerk lifting) and long durationlow magnitude loads due to more normal physical activ ity. This
division is important, because the disc ex hibits time-dependent
properties such as visco elasticity characterized by load-rate
sensitivity, hys teresis, creep, and relaxation.
Short-duration, high-level loads cause irrepar able structural
damage of the intervertebral disc when a stress of higher value than
the ultimate fail ure stress is generated at a given point. The mecha
nism of failure during long-duration, low-level, re petitive loading of
relatively low magnitude is entirely different and is due to fatigue
failure. A tear develops at a point where the nominal stress is r la
tively high (but much less than the ultimate or e.ven yield stress),
and it eventually enlarges and results in complete disc failure.
Biomechanical behavior of the disc is dependent upon its state of
degeneration, which in turn is age dependent. From a study of 600
lumbar interver tebral discs that had been cut through the mid-disc
plane and visually graded for disc degeneration on a scale of 1 to 4,
Miller and colleagues found that (1) disc degeneration first appears
in males in the sec ond decade and in females a decade later, (2) by
age 50, 97% of all lumbar discs are degenerated, and (3) the most
degenerated segments are L3-L4, L4-L5, and L5-S1 .
Biomechanically Relevant Anatomy
The intervertebral disc has probably received as much attention as
any anatomic structure in the enlire spine complex, with the
exception of the spinal cord. It constitutes 20-33% of the entire
heighl of the vertebral column. The intervertebral disc is comprised

of three distinct parts: the nucleus pulposus, the annulus fibrosus,

and the cartilaginous end-plates.
Nucleus Pul osus The nucleus pulposus is a cen trally located area
composed of a very loose and translucent network of fine fibrous
strands that lie in a mucoprotein gel containing various
mucopolysaccharides. The water content ranges from 70-90%. It is
highest at birth and tends to decrease with age.l75 With the help of
MR!, it can be measured in ViVO.176 The lumbar nucleus fills 3050% of the total disc area in cross-section. In the low back, the
nucleus is usually more posterior than central and lies at about the
juncture of the middle and posterior thirds of the sagittal diameter.
The size of the nucleus and its capacity to swell are greater in the
cervical and lum bar regions.
Annulus Fibrosus The annulus fibrosus is a por tion of the
intervertebral disc that gradually be comes differentiated from the
periphery of the nu cleus and forms the outer boundary of the disc.
This structure is composed of fibrous tissue in concentric laminated
bands (Fig. 1-2A, 8). The fibers are ar ranged in a helicoid manner.
They run in about the same direction in a given band but in opposite
direc tions in any two adjacent bands. They are oriented at 30' to
the disc plane and therefore at 120' to each other in the adjacent
bands (Fig. 1-28, C). The an nulus fibers are attached to the
cartilaginous end plates in the inner zone, while in the more periph
eral zone they attach directly into the osseous tissue of the
vertebral body and are called Sharpey's fibers. This attachment to
the vertebra is a good deal stron ger than the other more central
attachments, which is a useful characteristic in the clinical
evaluation of spine trauma, clinical stability, and surgical con
structs. Three-dimensional architecture of the col lagen framework
has been studied,I08 and mor phological changes with aging have
also been studied.
Cartilaginous End-Plale
This is composed of hy aline cartilage that separates the other two
compo nents of the disc from the vertebral body.
An excellent histological study of the lumbar ver tebral end-plate
and its changes with age [0-37 years) has been provided. Starting
with an active
growth cartilage, the age changes result in irregu larly arranged
growth cartilage, which disappears with time and is replaced by
bone.