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When looking at the lumbar spine, you will note that between each vertebra is a block of tissue that resembles a hockey puck. This "tissue" is actually a shock absorber that cushions the stress on the spine with bending, twisting, lifting, etc. It has a central area of extremely tough protein-Gelatin like material that is the cushioning part. This gelatin material is surrounded by a ring of thick material that is called the annulus and is layered much like a tire. Think of the outer portion of the annulus as the tread of a tire. There are blood vessels and nerves in the outer layers of this "ring" of tissue. As we get older the central gelatin material begins to dry out and the bending, twisting, heavy lifting begins to put more pressure and weaken this outer ring of fibers. They can actually tear from stress, resulting in a significant amount of pain (picture this as occurring in the center area of the "tread")... When rupturing of this annulus occurs and the thick gelatin material pushes out beyond the annulus we call this a herniated disk. If the material remains within the annulus it is considered “subligamentous”… Imagine looking down on the lumbar spine from above with the abdomen at “NOON”, and the back is at “6 O’clock”… If the herniation occurs at 5 o'clock or 7 o'clock, the herniation can pinch (trap) a nerve as it is preparing to leave the spinal cord and travel down the body, resulting in a severe burning pain and possibly muscle cramps if the nerve travels to the spasming muscle. If the herniation occurs at the NOON position, since no nerves are close by, there is no pain (actually, there can be pain, but it is not from nerves being pinched... there are pain fibers in the disk). If the herniation occurs at the 6 o'clock position no nerves will be trapped or pinched because there is a lot of space in the spinal canal where the spinal cord travels.

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Q: What is left paracentral subligamentous discal extrusion?
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