78. A 47-year-old woman comes to the physician because of a 6-week history of severe low back pain. She recently moved heavy boxes in the attic. Neurologic examination shows no abnormalities. A spinal CT scan shows that the nucleus pulposus of the intervertebral disc between L5 and S1 is herniated. Which of the following structures has most likely degenerated this patient? A) Anterior longitudinal ligament B) Anulus fibrosus C) Posterior longitudinal ligament D) Supraspinous ligament E) Zygapophyseal joint capsule

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**Case Study: Intervertebral Disc Herniation**

**Patient Profile:**
- **Age/Gender:** 47-year-old woman
- **Presenting Symptoms:** Severe low back pain for the past 6 weeks
- **Recent Activity:** Moved heavy boxes in the attic

**Clinical Findings:**
- **Neurologic Examination:** No abnormalities detected
- **Imaging Results:** Spinal CT scan reveals a herniation of the nucleus pulposus of the intervertebral disc between lumbar vertebrae L5 and sacral vertebra S1.

**Question:**
Which of the following structures is most likely to have degenerated in this patient?

**Options:**
A) Anterior longitudinal ligament  
B) Anulus fibrosus  
C) Posterior longitudinal ligament  
D) Supraspinous ligament  
E) Zygapophyseal joint capsule  

**Explanation:**
This case presents a classic example of intervertebral disc herniation, commonly referred to as a herniated disc. The herniation typically involves the nucleus pulposus, which is the inner core of the intervertebral disc. In this patient, degradation of the anulus fibrosus (option B), the tough outer layer of the disc that contains the nucleus pulposus, is most likely the contributing factor to the herniation.

**Educational Notes:**
- The **anulus fibrosus** surrounds the nucleus pulposus and maintains its position within the disc. Degeneration or weakening of the anulus fibrosus can lead to the nucleus pulposus protruding out, causing a herniation.
- Symptoms of herniated discs often include pain, numbness, or weakness in the areas served by affected nerves.
- Common risk factors include age-related degeneration, repetitive movements, heavy lifting, and trauma.

Understanding the structural and functional aspects of intervertebral discs and spinal ligaments is essential for diagnosing and managing back pain related to disc herniation.
Transcribed Image Text:**Case Study: Intervertebral Disc Herniation** **Patient Profile:** - **Age/Gender:** 47-year-old woman - **Presenting Symptoms:** Severe low back pain for the past 6 weeks - **Recent Activity:** Moved heavy boxes in the attic **Clinical Findings:** - **Neurologic Examination:** No abnormalities detected - **Imaging Results:** Spinal CT scan reveals a herniation of the nucleus pulposus of the intervertebral disc between lumbar vertebrae L5 and sacral vertebra S1. **Question:** Which of the following structures is most likely to have degenerated in this patient? **Options:** A) Anterior longitudinal ligament B) Anulus fibrosus C) Posterior longitudinal ligament D) Supraspinous ligament E) Zygapophyseal joint capsule **Explanation:** This case presents a classic example of intervertebral disc herniation, commonly referred to as a herniated disc. The herniation typically involves the nucleus pulposus, which is the inner core of the intervertebral disc. In this patient, degradation of the anulus fibrosus (option B), the tough outer layer of the disc that contains the nucleus pulposus, is most likely the contributing factor to the herniation. **Educational Notes:** - The **anulus fibrosus** surrounds the nucleus pulposus and maintains its position within the disc. Degeneration or weakening of the anulus fibrosus can lead to the nucleus pulposus protruding out, causing a herniation. - Symptoms of herniated discs often include pain, numbness, or weakness in the areas served by affected nerves. - Common risk factors include age-related degeneration, repetitive movements, heavy lifting, and trauma. Understanding the structural and functional aspects of intervertebral discs and spinal ligaments is essential for diagnosing and managing back pain related to disc herniation.
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