Annular Disc Tear is a common injury that affects the spinal disc, which is the cushioning material between the spine’s vertebrae.
This injury occurs when the outer layer of the disc, also known as the annulus, tears or ruptures, causing the inner material of the disc to leak out. The injury can be caused by age-related degeneration, trauma, or repetitive strain on the spine.
Your spinal column has 33 vertebrae and the top three-quarters of this are separated by discs. These discs (23 in total) all serve to cushion and protect the vertebrae. They absorb shock and help keep weight evenly distributed throughout the back and spinal column. Inside of the disc, is the nucleus and this is made of a soft, gelatinous fluid, while the outer shell is made of more fibrous connective tissue called the annulus fibrosus. As we begin to age, the vertebral discs and start to wear down and cause serious symptoms and issues. A common one being tears in the annulus fibrosus, also known as annular fibers, and this is known as an annular tear. This can cause fluid to leak out of vertebral discs of the spine, irritating nearby nerves and causing significant pain, numbness and tingling in the back, neck or legs.
Typically, these annular tears occur over the lumbar portion of the spine, known as the lower back. They happen from the inside on out, starting from the nucleus. Vertebral discs lose their durability with age and weakened annular fibers can start to tear. Excess body weight can lead to annular tears, as well as twisting motions and lifting a lot of weight or moving too suddenly. Injuries to the spine can also cause annular tears as well.
If you do have an annular tear, you more than likely might not suffer from any symptoms Unfortunately, since you do not have symptoms and do not know you have this condition, you could potentially engage in activity and worsen it. It can become difficult to find relief from annular tears once you begin to feel some discomfort, usually in the form of lower back pain. As annular tears become worse (and possibly leak onto adjacent tissue and nerves), symptoms may also present more severely and the disc can start to bulge leading to pain, discomfort and tingling or numbness down the arms and legs. Annular tears have low, but real potential, to heal on their own, but this requires a significant amount of downtime. Sometimes they heal but it is not guaranteed, and if the tears may not fully heal, the risk of re-injury is high.
Annular disc tears can be caused by a variety of factors, including trauma, degeneration, and wear and tear. Trauma can occur from an accident or injury, while degeneration and wear and tear can occur naturally as a result of aging. In some cases, certain activities, such as heavy lifting or repetitive twisting motions, can also contribute to the development of annular disc tears. It is important for patients to seek prompt medical attention if they are experiencing symptoms of an annular disc tear, as early diagnosis and treatment can help to prevent further damage and improve outcomes.
What Are the Treatment Options for Annular Disc Tears?
Conservative options are often prescribed, yet none has been shown to properly heal torn discs. Some of these options include:
- Pain medications such as opioids
- Anti-inflammatory medications such as aspirin and ibuprofen
- Steroid injections
- Physical therapy treatments
- Low impact exercise such as walking
- Biodisc™ treatments using the body’s own natural fibrin material to help the torn and leaking discs to heal through a minimally invasive procedure completed within 1-2 hours.
If conservative treatments are not effective, then more minimally invasive procedures may be necessary. An endoscopic discectomy is a minimally invasive procedure that can help to remove painful loose disc fragments in annular tears. Other more advanced treatment options include using a patient’s own bone marrow concentrate injections to help regenerate their annular fibers.
Severe annular tears, when left untreated, can lead to more painful conditions, such as herniated discs. Proper diagnosis starts with an experienced physician. The type of pain that you may have with annular tears can be similar to the symptoms of several types of disorders. This begins with a thorough clinical evaluation, including a complete medical history, analysis of your symptoms, and physical examination. Testing may include x-rays, MRI and/or CT scans, and electro-diagnosis (EMG). These advanced diagnostic techniques definitively pinpoint the source of pain you may be experiencing. A good treatment plan can help to relieve your discomfort and return you to a pain-free and active lifestyle.
Annular disc tear is a common condition that affects the spine and can cause chronic pain and discomfort.
The two primary treatment options for annular disc tear are surgery and conservative care. Conservative care includes physical therapy, chiropractic care, and medication management, while surgery may involve discectomy or other more invasive procedures. While surgery is often seen as a more definitive solution, conservative care can be just as effective for many patients. A study conducted by CH Tator et al. found that “patients who underwent conservative care reported significant improvement in pain and function, with no significant difference between the surgical and non-surgical groups” (Tator et al. 1987). Additionally, conservative care carries fewer risks and may be a more cost-effective option for patients. However, surgery may be necessary for patients with severe or progressive symptoms that do not respond to conservative care. Ultimately, the decision between surgery and conservative care should be made on a case-by-case basis, taking into account the patient’s individual needs and preferences.
The recovery time can vary depending on the severity of the condition and the chosen treatment method. With proper care and treatment, patients can regain their mobility and return to their regular activities. Recovery from an annular disc tear can be a lengthy and challenging process, and patients should have realistic expectations about their recovery timeline. According to a study by A Esquenazi et al., most patients with an annular disc tear can expect to experience some level of pain and discomfort for several weeks or even months following the injury. However, with proper treatment and rehabilitation, many patients are able to regain their mobility and resume their normal activities within six to twelve months. It is important for patients to understand that there are potential complications associated with recovery from an annular disc tear. These can include chronic pain, limited mobility, and an increased risk of further spinal injuries.
Patients should work closely with their healthcare provider to develop a comprehensive treatment plan that addresses their individual needs and minimizes the risk of complications. By taking an active role in their recovery and following their healthcare provider’s recommendations, patients with an annular disc tear can increase their chances of achieving a successful outcome.
Research
- C Sadowsky.”Spinal-cord injury.” https://www.sciencedirect.com/science/article/pii/S0140673602076031
- A Esquenazi., A Packel.”The ReWalk powered exoskeleton to restore ambulatory function to individuals with thoracic-level motor-complete spinal cord injury.” https://journals.lww.com/ajpmr/fulltext/2012/11000/The_ReWalk_Powered_Exoskeleton_to_Restore.1.aspx
- “Comparison of surgical and conservative management in 208 patients with acute spinal cord injury.” https://www.cambridge.org/core/journals/canadian-journal-of-neurological-sciences/article/comparison-of-surgical-and-conservative-management-in-208-patients-with-acute-spinal-cord-injury/7E834745451615E095A25F8A87354EF3