What is an annular tear?
The intervertebral disc is the shock absorber of our spine and serves as the cushion between two vertebrae. The disc is made of a strong outer ligamentous ring called the annulus fibrosus and inner jelly-like section called the nucleus pulposus. Both of these structures work together to evenly distribute pressure across the disc.
An annular tear is a condition when there is a tear in this outer layer, the annulus. When it is torn, there is a leak of inflammatory proteins that irritates the nerve fibers that are present in the annulus.
Although annular tears can occur anywhere throughout the spine, they occur most commonly in the neck and low back as these areas are the most mobile.
What causes an annular tear?
Annular tears are mainly caused by wear and tear over time. As we age, the discs lose hydration and flexibility which causes the outer layer, annulus, to tear more easily. They can also be caused by playing sports (ie football, hockey), working in strenuous occupations (ie construction), from accidents (ie falls), or high impact activities. They can also be caused by excessive body weight which causes increased pressure on the vertebrae and discs.
What are the symptoms of an annular tear?
Annular tear symptoms vary depending on how severe the annular ligament tear is. If you have a minor annular tear, you may not have any symptoms. With larger annular tears, the disc material can leak out and put pressure on the nerves and spinal cord. Most commonly, patients report pain and muscle spasms in the neck, mid, or low back. Symptoms also worsen with activity, sitting, or positions that load pressure on the disc. Patients may even report pain with coughing, sneezing, bending forward, or lifting.
Other symptoms include:
- Constant low level back pain
- Pain radiating across the abdomen or the groin
- Pain radiating down the leg, which is worse with changing position
- Pain in the arms or leg, depending on which annulus is torn
- Numbness, tingling in the arms or legs.
Diagnosis of Annular Tears
Dr. Webb will typically perform a history and physical exam to help him make the diagnosis. X-rays will be taken to evaluate your spinal anatomy from a structural standpoint. If warranted, a MRI will then be ordered.This is usually done after a few weeks of therapy. A MRI may allow the annular tear to be seen and help Dr. Webb rule out other causes of back pain. Sometimes, a CT discogram is ordered if a MRI is contraindicated (metal in your body). In this procedure, a liquid dye is injected into the disc and observed on CT scan. The dye will contrast with the disc, and any tears can then be spotted.
Treatments for Annular Tears
Most annular tears are treated conservatively. Small and even large annular tears are able to heal themselves without surgery. However, because the annulus has such a limited blood supply, annular tears can take a quite long time to heal on its own. The time it takes for an annular tear to heal may be from weeks to months.
Dr. Webb uses a graded treatment algorithm which starts with the least invasive options and then moves to surgical options when all other treatment modalities have failed.
Level I – Conservative treatments
- Physical therapy: this strengthens the surrounding muscles of the back and improves posture, thus helping to relieve the pain from the annular disc.
- Oral pain medications: ibuprofen, naproxen, aspirin, anti inflammatory meds
- Muscle relaxants
Level II – Spinal Injections
- Epidural steroid injections: with X-ray or ultrasound guidance, steroid medication is injected near the annulus to alleviate the pain during the healing process.
Level III – Surgery
- Surgery is used only as a final resort when all other options have failed. This usually entails performing procedures to take the pressure off of the nerves and spinal cord.
Frequently asked questions about annular disc tears
Can an annular disc tear heal itself?
-Yes, annular tears can heal themselves over time by forming scar tissue over the torn area.
How can I prevent an annular tear?
-Maintaining great overall health is the best way to prevent annular tears. In addition, watching your weight, not smoking, exercising, and maintaining flexibility all help to keep your spine in great health. The better shape you stay in, the lower the chances of you getting an annular tear.