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I wanted to go over once again the terminology

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that the consensus group utilizes for the

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description of the location

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of disc herniations.

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The four terms that are used are the central

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canal zone, the subarticular zone,

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the foraminal zone,

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and the extraforaminal zone

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or far lateral zone.

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Lateral recess is also referred to and is

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synonymous with the subarticular zone.

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I usually don't use the term zones.

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I usually refer to the disc herniation as a

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central disc herniation or subarticular disc

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herniation or lateral recess disc herniation.

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Rather than referring to these zones,

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but you see them on this nice diagram.

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Although they don't use the term

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specifically paracentral,

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when the disc herniation extends from

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the right side or to the left side,

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I will usually use that term to say that there

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is a right paracentral disc herniation

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referring to that portion of the central

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zone that is off to one side,

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either the right or the left.

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The subarticular zone, again,

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refers to that area of the lateral recess

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where we should be seeing the pedicle.

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The foraminal disc herniations, obviously,

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are in the neural foramina,

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and the ones that are little less common are

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the extraforaminal ones way out laterally,

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where they may actually not be in contact

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at all with the exiting nerve roots.

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So this terminology is something that should

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be utilized in describing the location

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of the disc herniation.

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The nomenclature consensus also uses the terms

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for the superior inferior location

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of the disc herniation.

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I have to admit that I do not use this at all.

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However,

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in the interest of making sure that

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we're all on the same page,

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we should look at those locations.

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So, this is a coronal diagram showing the

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intervertebral discs and the terms that they

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recommend for describing where it is

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in a superior inferior dimension.

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So, here is the disc.

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Let's just say that this is L5-S1.

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And here is the disc.

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And let's just say that this represents L4-L5.

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Most of the discs herniations obviously

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are going to be at the disc level,

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which is why I don't typically utilize

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this type of terminology. However,

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the nomenclature refers to those disc

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herniations that are below the

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pedicle, at the pedicle level,

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these would generally be our disc herniations

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in the lateral recess, and then the suprapedicle

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level. The problem with this terminology is,

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I find, is that sometimes when you're talking about

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a disc at L4-L5 that's going down below,

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you may be confusing an inferiorly located

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suprapedicular disc herniation.

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So, something that I will say,

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do as I say, not as I do.

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I'm not a big fan of this terminology,

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but it is the way we should describe the

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superior or inferior migration of a disc

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herniation and where it is located in a

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superior-inferior dimension, as opposed to the

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transverse location in which we use central

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subarticular foraminal and extraforaminal .