What is Annular Tear?
Written by Neil Badlani, M.D., Chief Medical Officer, North American Spine

Many people will suffer from back discomfort or pain at some time in their lives. Sometimes people believe that back pain and discomfort is part of getting older. However, the pain can be an indication of a more serious condition than a pulled muscle or simple ache. It could be an annular tear. 

A person’s spinal column is very elaborate. It has 33 vertebrae. The top three-quarters of the spinal column are separated by what are called discs. These 23 discs have the responsibility of protecting and providing cushion for each of the vertebrae. For example, the discs absorb shock. They also keep a person’s weight evenly distributed on both sides of their body.

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More About Annular Tear

lumbar foraminotomy

Inside each disc is soft fluid that resembles gelatin. The outer part of each disc is a hard shell made of connective fibers. These connective fibers are known as annulus fibrosus. As a person grows older, the discs in their spinal column often become worn. The wear can lead to health problems. One common health problem is a tear in the annulus fibrosus. The tear is what’s called an annular tear. 

An annular tear develops in a person’s lower back or lumbar spine. This type of tear typically occurs in the inside of the disc where the soft, gel-like is located. Annular tear symptoms depend on the tear. A minor tear may not cause many symptoms. However, as the tear progresses, the gel-like fluid begins to leak from the disc.

Wear and age are not the only reasons why a disc tears. An injury can cause an annular tear. Normal wear and tear on a person’s body can also cause the tear in a disc. Normal wear and tear on discs often occur when a person is on auto-pilot. This means they are going about their daily tasks without thinking about their posture, walking or other routine movements. Bad habits such as slouching, binding to pick up things and climbing the stairs can lead to an annular tear. 

A tear in a disc does not seem like it can lead to serious symptoms. However, it can do a lot of damage. The tear in an interior disc actually weakens the disc. This increases the chances that the torn disc could future deteriorate. For example, the deteriorating disc could impinge on the person’s spinal nerve. To learn more about the condition, let’s look at annular tear symptoms, pain and annular tear treatment. 

What are the symptoms?

The symptoms of an annular tear depend on the severity of the tear and its location in a person’s spinal column. Annular tear back pain is present regardless of the severity and location of the tear. It’s important to take look at the symptoms involved with a partial and full annular separately. 

A partial annular tear is the result of weakness in the outer area of the disc called the annulus fibrosus. This type of tear does not fully penetrate the outer layer of the disc. In other words, the outer tear does not separate the inside of the disc. Unfortunately, a partial tear can expose the nerve endings in the disc’s soft gel-like area. This can irritate a person’s exposed nerve endings. 

A person experiences pain. If the tear is in a person’s lower back, the pain will move to at least one of their legs. The pain will worsen if a person sneezes, coughs and lifts objects. As the partial tear worsens, the pain may worse when a person sits downs. 

A full annular tear penetrates the inside and outside of the disc. It will result in a herniated disc. The disc will become compressed. This means pressure is placed on the nerve roots in a person’s spinal cord. Symptoms for a full annular tear include back pain. The pain will be in a localized area such as the middle or lower back. Symptoms also include: 

1. Tingling 
2. Numbness 
3. Burning 

Another symptom is changes in a person’s nervous system. The pain will typically radiate outward. Thus, the pain moves from the injured disc to other areas of the body such as the legs or arms. 

Simple activities can worsen an annular tear. The pain typically worsens because a person uses their back in almost every task such as walking and sitting. The pain may also worsen when the disc begins to bulge. 

How Annular Tear is Diagnosed

An annular tear is typically diagnosed after a person goes to see their doctor about back and/or neck pain. A doctor trying to find the cause of the back or neck pain will go through a series of steps to discover the cause of the pain.

•  Physical Examination:

A physical examination is the next step in diagnosing an annular tear. During a physical examination, the doctor looks at the person’s back, neck, joints and supporting musculature. An individual undergoing this physical examination must be prepared to describe the symptoms they’ve been experiencing and the severity. They should also be prepared to tell the doctor all the daily activities they do during the course of the day. These activities could lead to an injury that created an annular tear. During the physical examination, the doctor will pay attention to the person’s spinal alignment, posture and palpate of the spine by pressing their hands against the backbone and neck. 

•  Medical Review:

The first step in diagnosing an annular tear is a review of medical records. A doctor will conduct a medical history of the individual complaining of back or neck pain. This occurs when a series of questions are asked to determine if the person has a prior history of back problems or family history of annular tears. 

The doctor will carefully review the person’s medical history and their medical records to determine if they have a genetic predisposition or pre-existing condition that could cause the back and/or neck pain. The review of medical records will also serve as a way to detect and identify any types of pervious injuries or activities that could have caused the symptoms.

•  Diagnostic Imaging:

The last step in diagnosing an annular tear is for the individual to undergo medical imagery. This means the person undergoes a medical scan such as a X-ray, CT scan or Magnetic Resonance Imaging (MRI). These tests are conducted to identify any location where there is a tear in a person’s discs. The tests are also performed to identify any type of underlying conditions the individual may have.

Causes of Annular Tear

low back pain

The main cause of an annular tear is growing older. Discs in the spinal column lose their durability as a person grows older. This causes the discs to weaken. The annular fibers soon begin tearing. Other things can cause an annular tear such as excess body weight. Excess body weight places a lot of pressure on the vertebrae and discs. 

Daily tasks can cause an annular tear such as twisting and bending. These tasks can cause small tears in the annulus fibrosus. An injury can also cause an annular tear. For example, a person who is in a car accident could suffer an annular tear. 

How are Annular Tears Treated?

Conservative Options

Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.

Decompression

Minimally invasive decompression surgery aims to relieve pressure on the nerves of the spine. This pressure is often caused by stenosis, bulging or herniated discs, and more. Relieving this pressure can be achieved by reducing or removing soft tissue (disc material or scar tissue) or bone (bone spurs, a section of the lamina or foramina) to decompress the affected nerve. When the compression is caused by soft tissue material, a surgical laser may be used to shrink the impinging material.

Fusion/Stabilization

Fusion surgeries are similar in goal–to remove damaged disc tissue and fuse the bones together–but differ in approach, including the use of specialized hardware to reinforce stability, and the location used to gain access to the spine. A related procedure is an artificial disc replacement, in which a damaged cervical disc is replaced with a synthetic disc, and the vertebrae are not fused.

How Much Does Treatment Cost?

Treatment cost depends on several factors, especially what insurance you have and how much of your deductible has been met. IN the last two years, 90% of our patients have paid less than $2000 out-of-pocket. Some have paid literally nothing, and other have paid much more than that. It depends. The good news is: our Patient Care Managers will handle as much as they can directly with your insurance company, and all your costs will be known up-front.

Important note: spine surgery often pays for itself within a year or two. Many people actually spend more money trying to live with the pain than they do getting the pain fixed. The following calculator is intended to give you a sense of what you spend on managing—rather than eradicating—your pain.

 

Calculate how much you've spent on back pain this year.
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This past year you have spent on your pain treatment:

Get surgery now. Getting surgery now is the smartest financial move. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. You’ve spent that much or more this year to manage your back pain than you could to fix it.

Get surgery soon. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. At your current rate, you will spend that much or more within the next two years. The sooner you get treatment, the sooner it will pay for itself.

Keep an eye on your spending. Currently, you are managing your pain efficiently from a financial perspective but over time, your expenses could add up. Surgery should be strongly considered if you start missing more work or spending more on treatment medication.

Great job! You are spending very little on your back pain. Keep it up!

Equipment Used to Diagnose and Treat Annular Tear

A doctor trying to determine if a person has one or more annular tears will use equipment to diagnose the condition. This equipment includes X-ray, CT scan or an MRI. An MRI is one of the best ways to diagnose an annular tear. Thus, this is often the first test a doctor chooses to aid in determining whether an individual has an annular tear. 

Another option is a CT discogram because an MRI may not show all the tears in one or more discs. This requires liquid dye to be injected in the disc to look for tears. Another option is an X-ray. To treat an annular tear, surgical equipment may be used. However, this treatment option only applies for severe tears in the disc. 

How Does Annular Tear Compare to Other Conditions

An annular tear differs from other medical conditions affecting the spine in many ways. The tear most often occurs from the inside of the disc. Other spinal conditions causes pressure on the spine that requires surgery or some form of treatment to relieve the pain. 

Another difference between an annular tear and other types of spinal conditions is that is often due to aging. This means a person does not have to suffer some kind of accident to experience an annular tear. 

However, an annular tear pain is similar to a herniated disc. A herniated disc bulges from its location. This can cause weakness, tingling and numbness in a person’s legs and arms. Annular tear pain causes the same type of symptoms.

Analogy: A Baseball

Think of each of your spinal discs as a baseball. The casing of the baseball is strong enough to keep the insides of the baseball intact during normal situations. However, age, wear-and-tear, or one really good wallop could cause the outer casing to tear. The difference between a torn disc and a ripped baseball is annular tears usually begin from the inside.

Good Baseball

Bad Baseball

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