Annular Tears. Are They Serious?
The MRI results are in. There is an annular tear at L5/S1. That sounds terrifying! It could be called an annular fissure (not quite as terrifying) but these are actually a common result of aging, and sometimes trauma, to the spine.
Discs are the shock-absorbing cushions between each vertebra of the spine. Surrounding each disc is a strong outer ring of fibers, called the annulus fibrosus. The inside is a soft, jelly-like center, called the nucleus pulposus. The annulus is the strongest area of the disc and the outer third of the ring is enervated with pain fibers.
If there is a tear or an opening in the annulus, it can be asymptomatic to extremely painful. Symptoms can be similar to a herniated disc. They may include pain, numbness, weakness and/or electrical sensations that travel down one leg or arm. The tear may heal with scar tissue, but it will always be more prone to future tears. It could also lead to accelerated degeneration to the disc itself.
Diagnosis and Treatment
Though an annular tear is often diagnosed on an MRI, many physicians also order a discogram to see if this is the actual pain generator. Though popular in the past, discograms are now considered by many to be to unnecessarily painful, not completely accurate and may lead to accelerated degeneration of the disc.
Treatment for an annular tear or fissure is generally conservative. A physical therapy program, low-impact exercises, anti-inflammatories are usually effective. Should these measures not be effective, steroid injections or even surgery may be recommended.
The best advice: give it time and keep moving. Like many spine problems, the body will look after itself.
For more information and Dr. Shim’s opinion on annular tears, high Intensity zones and even discography, please click on the above video.
- Motiei-Langroudi R, Sadeghian H, Seddighi AS. Clinical and magnetic resonance imaging factors which may predict the need for surgery in lumbar disc herniation. Asian Spine J. 2014 Aug;8(4):446-52. PubMed PMID: 25187861
- Simon J, McAuliffe M, Shamim F, Vuong N, Tahaei A. Discogenic low back pain. Phys Med Rehabil Clin N Am. 2014 May;25(2):305-17. PubMed PMID: 24787335
Last modified: December 11, 2020