Can intervertebral disc prolapse be predicted by disc mechanics?

The hypothesis was tested that stress concentrations in the posterior anulus of an intervertebral disc predispose it to prolapse under high compressive loads and anterolateral bending. The distribution of compressive stress inside the intervertebral discs of 22 cadaveric lumbar motion segments was measured with the specimens loaded in pure compression and in compression combined with anterolateral bending. Each motion segment was then loaded to failure in combined compression and anterolateral bending. Failure occurred in the vertebral body (n = 12) or posterolateral anulus (n = 10); the latter group showed a significantly greater incidence of stress concentrations (P < 0.001) in the posterior anulus, when loaded in compression and bending. It was concluded that some discs are predisposed to prolapse because of damaging, localized concentrations of stress in the posterior anulus in combined anterolateral bending and compression.