Combined Task Forces 2014:Nomenclature and Classification of Lumbar Disc Pathology.
The previous 2001 (and 2003) Recommendations of Nomenclature and Classification of lumbar disc pathology (Fardon et al) was modified in 2014 and is the current standard for Neuroradiological usage in many parts of the world. Please refer to an earlier article on the prior Recommendations.
In 2014 the Guidelines regard (A) Bulge (general displacement of annulus >25% circumference and generally <3mm beyond edges apophyses) and (B) Herniation is localised displacement <25% (Subgroup Herniations are :(i)Protrusion:largest diameter extension < base herniation) and (ii)Extrusion(diameter extension > base diameter) and (iii)Intravertebral herniation or Schmorl's node.
So there are precise morphological definitions of Bulges, Herniations, Protrusions and Extrusions.Sequestrations are also type of Herniation in which there is no visible continuity with the parent disc.
The text NeuroImaging Part II also refers to these definitions (Version 2 Lumbar Combined task Force Fardon et al 2014) ( Table 39,page 793,R.Gilberto Gonzalaez and Joseph Masedev).
The Combined Task force comprises the North American Spine Society(NASS), American Society of Spine Radiology(ASSR) and American Society of Neuroradiology(ASNR).
The use of standardised nomenclature is intended to maintain consistency and accuracy in normal and abnormal lumbar disc descriptions. The Combined task force emphasises that terms such as annular fissure, annular tear, disc protrusion/herniation/prolapse do NOT denote or imply a traumatic or non-traumatic causation.This appears in all the publications.
These guidelines to lumbar disc change nomenclature were adopted in total by the RANZC Radiologists at their 2015 ASM.
Patients and IMEs are advised to follow the advice of their treating medical practitioner / indemnity insurer at all times.The opinions stated herein are those of the author.
Dr Michael Coroneos is a senior Brisbane neurosurgeon with six surgical Fellowships and was honoured to be elevated to Master CIME status by the American Board of Independent Medical Examiners (by 3 examinations and training) in May 2017.