Isolated Disc Resorption (IDR)

An Overview of Isolated Disc Resorption (IDR) of the Lumbar Spine

Isolated disc resorption (IDR) of the lumbar spine is the end spectrum of degenerative disc disease of the lumbar spine. Initially, disc wall tears herald the start of degenerative disc disease. Eventually, the nucleus (the jelly of the donut) loses its ability to hold water and the disc then settles (drops in height). This is similar to a car tire losing air and the walls of the tire bulge out.

The increased pressure on the walls of the disc produces increased stress. The additional forces on this degenerative disc include shear, compressive and rotational forces. More tears can occur over time and the disc can become increasingly incompetent. These abnormal forces can start to wear out all the internal components of the disc including the cartilaginous endplates. Eventually in some discs, this degeneration causes all of these materials (nucleus and endplate) to fully wear away.

Open one of these isolated disc resorption discs and you will find nothing in the disc space but raw bone surfaces. The material within these discs has absorbed away. The annulus remains, normally torn but generally intact.

These changes in the structural dynamics cause symptoms different than the typical back pain most of us know. In the IDR disc, there is no shock absorption capability remaining and the two bony vertebral endplates are set against each other. This creates a real problem with exposure to vibration and impact forces.

Prolonged exposure to vibration from riding in a car or from an airplane ride, impact activities such as jumping, running and tennis will cause pain. Something as simple as stepping off an unexpectedly steep curb will cause a sharp, deep pain in the back. Heavy lifting or prolonged bending will also cause the same type of pain but of a more dull nature.

The isolated disc resorption (IDR) disc will also cause delayed onset pain. This is pain that occurs from 4-12 hours after an overload activity. Most patients note that with loading or impact activities, they “pay for it later”. The quality of this delayed onset pain is an intense dull throbbing ache.

This delayed pain is caused by fractures that occur within the vertebral body in small structural web-like bones called the trabecula. These tiny bones are like a honeycomb inside the vertebra that reinforces the walls. The trabecula are normally protected by the shock absorption capacity of the disc.

When the disc fails, the increased forces on the endplates overcome the structural integrity of these trabecula. When they fracture, raw bone is exposed. This triggers the inflammatory cascade.

The delayed timing of pain is due to the nature of the inflammatory cascade. This chemical cascade is set off when exposed proteins trigger certain immune cells to release their chemical signals. These chemicals in turn cause other cells to migrate into the area and trigger more chemical releases. This cascade eventually sensitizes the nociceptors (pain receptors).

This cascade “revs up” slowly. It takes about 6-12 hours for a cut on your finger to develop red, inflamed edges. This is the same delayed type of reaction that occurs in the spine. There are multiple chemical reactions that have to sequentially complete to fully activate inflammation and induce pain provocation.

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(Please keep reading below for more information on this condition.)

MRI and CT Findings of IDR

The MRI findings of isolated disc resorption (IDR) are classic. First, the disc will be very narrowed and have lost most of its original height. The disc space will appear black due to the loss of water from the nucleus and then loss of the nucleus itself.

The cortical endplates of the bone, which are normally uniform and regular, are found to be irregular with small endplate fractures. Some call these “moth-eaten” or “rat-bite” appearances.

The inside or internal body of the vertebra will be whitened along these fractured edges (noted on a T2 image in which water is white). This is due to fluid accumulation from the fractured trabecula, which seeps into this area.

CT scans might demonstrate sclerosis (whitening) of the bony endplates due to Wolf’s Law. Wolf’s Law states that any bone that is overloaded will grow new bone to accommodate the increased stress.

Treatment of Isolated Disc Resorption

Not all vertebral bodies that have isolated disc resorption are painful. This again goes back to wiring. Some individuals are wired to have back pain and some are not. In addition, this might be a painful and even debilitating condition but it is not dangerous to live with. If IDR is found on studies but there is no significant lower back pain, treatment does not need to be considered.

With significant back pain and IDR present, treatment of this condition initially requires a good therapy program (core strengthening) and medications. NSAIDs (non-steroidal anti-inflammatory drugs) are a good first-line medication. Activity avoidance of significant impact activities and heavy lifting are generally necessary to reduce pain provocation.

If patients fail conservative treatment methods, lumbar fusion surgery (normally a TLIF) for isolated disc resorption works very well in the correctly selected patient.

For additional resources on isolated disc resorption (IDR) of the lumbar spine, please contact the office of Dr. Donald Corenman, spine specialist and neck doctor offering diagnostic and surgical second opinions to patients in the USA and around the world.

Related Content

(Click to Enlarge Image) Schematic of endplate and annulus with nucleus. Note the cartilage endplate shields the nucleus from the bone of the vertebral body. The annular fibers directly insert into the bone through Sharpey’s fibers.

(Click to Enlarge Image) Pressure drop of nucleus causes increased stress on disc wall. The wall of the disc was designed to hold the pressurized nucleus in and to resist rotation but is not designed well to resist compression.

(Click to Enlarge Image) Normal MRI Discs are all well hydrated noted by the bright white color and excellent height.

(Click to Enlarge Image) Mild Degenerative Disc Disease The arrow points to the L4-5 disc which has lost its white signal. The disc still has good height remaining and the endplates are smooth and intact.

(Click to Enlarge Image) Isolated Disc Resorption The white arrow points to the fully degenerated disc. Notice that the vertebral bodies surrouning this disc space are whiter than the other vertebra due to the leakage of fluid into the bone from the trabecular fractures.

(Click to Enlarge Image) IDR The large white arrow points to the problem disc, the small white arrows to the endplate fractures and the black arrow points to the high white signal the fluid swelling inside the vertebral body.

Donald Corenman, MD, DC

Average rating:

81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

Isolated Disc Resorption-Lumbar Spine (IDR)

An Overview of Isolated Disc Resorption (IDR) of the Lumbar Spine

Are you suffering from symptoms of Isolated Disc Resorption (IDR) of the lumbar spine?

MRI and CT Findings of IDR

Treatment of Isolated Disc Resorption

Related Content

About the Author: Donald Corenman, MD, DC

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