Criteria for classifying normal and degenerated lumbar intervertebral disks

The purpose of this study was to develop criteria for distinguishing normal and degenerated lumbar intervertebral disks. Cryomicrotome sections from and magnetic resonance images of 31 cadavers were reviewed. The immature nucleus pulposus, found up to age 2 years; the transitional nucleus pulposus, found in teenagers; and the adult nucleus pulposus were associated with an intact anulus fibrosus without tears except for small concentric or transverse tears in the periphery of the anulus fibrosus. Discoloration of the nucleus pulposus, diminishing disk height, and diminishing signal intensity were associated consistently with a radial tear of the anulus fibrosus. The severely degenerated nucleus pulposus was associated also with a radial tear or complete disruption of the anulus fibrosus. The results suggest that intervertebral disk normally progresses from the immature to the transitional to the adult nucleus pulposus. When a radial tear develops in the anulus there is shrinkage and disorganization of fibrocartilage in the nucleus pulposus and replacement of the disk by dense fibrous tissue and cystic spaces.