Annular Tear

When the outer wall of an intervertebral disc ruptures, the result is an annular tear. In most cases, the rupture is incomplete, resulting in a partial tear. The fluid inside the disc leaks out, irritating nearby nerves and causing pain and/or tingling sensations. The tear may eventually lead to a herniated disc if the entire jelly-like interior of the disc leaks through.

Also known as a disc tear or an annular fissure, an annular tear occurs most often in the lower back. If you suffer from lower back pain for more than a few days, an annular tear is a possibility. Visit your doctor for an accurate diagnosis and treatment.

Intervertebral Discs

Intervertebral discs cushion the spine and act as shock absorbers and nerve protection. The ligament forming the outer shell of an intervertebral disc is the annulus fibrosus, while the gel-like inner center is the nucleus pulposis. The former has a significant nerve supply, while the latter is the fluid leaking from an annular tear.

Common Causes

As the body ages, it can wear out. That is the primary cause of annular tears, but trauma may also result in a disc wall rupture. Other common causes of annular tears include:

  • Falls
  • Motor vehicle accidents
  • Sports injuries

Symptoms

Annular tear symptoms mimic many other back issues. The condition is known as “The Great Masquerader.” Some people describe annular tear pain as “stabbing” or “shooting.” Besides back pain, annular tear symptoms include:

  • Arm and leg weakness
  • Numbness
  • Neck pain
  • Swelling from inflammation

Because the annular tear irritates nerves, pain may spread throughout the body, far from the injured disc.

Types of Tears

Three types of tears occur. These are:

  • Radial – starting mid-disc and going to the outer layer of the shell
  • Peripheral – occurring in the external shell fiber, often resulting from trauma
  • Concentric – occurring between the annulus fibrosus layers

Diagnosis

Doctors start the diagnosis by taking a medical history and performing a physical examination. The physician’s practiced eye may suspect annular tear from the way the patient moves. An X-ray eliminates the possibility of fractures.

Computed tomography scans are the diagnostic tool of choice for suspected annular tears. Nerve conduction tests determine the nerve root. Once the tear is detected, the doctor rates it on a scale of 0 to 6, with 6 indicating serious tearing and leakage.

Treatment

In most cases, the body slowly repairs the annular tear. Eventually, scar tissue forms, plugging the rip in the disc. This process may take months. However, the healing never completely makes the patient “as good as new” and re-injury is common.

During the healing period, the patient may respond to a combination of physical therapy, exercise, massage, hot and cold therapy along with over-the-counter non-steroidal anti-inflammatory drugs (NSAIDS) such as acetaminophen or ibuprofen. Hydrotherapy, or water therapy, is another good choice for annular tear patients.

If conservative treatments fail, other options include:

  • Corticosteroid injections
  • Short-term use of prescription painkillers
  • Minimally invasive surgery using lasers for disc decompression or sealing tears.

Conventional surgery becomes a last resort for relief of severe pain. The torn disc is partially removed in this procedure.

Talk to a Doctor

If you experience back pain and suspect you have an annular tear or other disorder, contact a skilled doctor today to discuss your options.