The Truth Regarding Annular Tear
By Neurosurgery Singapore
What is Annular Tear?
Annular tears are back injuries that develop in the spinal discs, which sit between the 33 vertebrae of the spine. The main functions of spinal discs are to cushion the vertebrae, absorb shock and help the spine move fluidly. The intervertebral discs have 2 components:
- An outer ring of tough ligament fibers called the annulus fibrosus
- An inner center of jelly-like fluid called the nucleus pulposus
A tear or crack in the tough outer ring is called an annular tear. The outermost layer of the annulus fibrosus is home to many nerve fibers, so tears can result in significant back or neck pain. Annular tears are most common in the low back and neck, because the cervical and lumbar regions are the most mobile and bear the most weight.
For patients over sixty, annular tears can also be an early sign of degenerative disc disease caused by osteoarthritis.
What are some symptoms of 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.
There are 3 major types of disc tears include:
Transverse Tears: Transverse tears begin in the outermost rim of the disc and can extend all the way to the nucleus. This is significant because the outer part of the disc is highly innervated with pain receptors. If you experience an annular tear here, it’s fairly difficult not to notice.
Radial Tears: These tears begin at the innermost portion of the annulus and can continue to crack until they reach the rim. Because these tears begin in the center of the disc where pain receptors are sparse, they do not always cause symptoms.
Concentric Tears: Concentric tears develop in a ring that encircles the nucleus of the disc. They are often the result of torsional injuries, or twisting the wrong way. (Think of throwing out your back while swinging a golf club.)
“Once you’ve developed an annular tear, you’re at a higher risk for developing future tears and damage”
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What types of diagnosis?
Our Spine Specialist will likely begin by requesting a complete medical history and conducting a thorough physical examination to determine where you’re feeling the pain. This involves palpating (or touching) the spine and investigating any painful areas A physical exam can also determine if the problem is affecting your range of motion.
Our doctor may also check your reflexes and your responses to certain sensations. This determines if your condition is affecting your nerves.
Imaging tests such as X-rays, MRIs and Nerve conduction tests may be necessary so our Specialist can check for:
- bone problems
- disc problems
- nerve problems
These can help your physician see any problems with the discs and other soft tissue in your spine and diagnose an annular tear if one is present.
Possible treatment methods?
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.
Our Spine Specialist 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: 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.