What is an annular tear, how do they happen, and how can individuals who suffer from back pain related to annular tears find some relief? Read on for everything you need to know about annular tears.
What is an Annular Tear?
Your Spinal column has 33 vertebrae and the top three-quarters of which are separated by discs. These discs, 23 in all, serve to cushion and protect the vertebrae; they absorb shock and help to keep weight in the back evenly distributed. The inside of the disc, the nucleus, is made of a soft, gelatinous fluid, and the outer half is made of tough connective fibers called the annulus fibrosus. As we get older, the vertebral discs can start to exhibit wear and cause some health problems. A common problem is a tear in the annulus fibrosus, or annular fibers commonly referred to as an annular tear.
Annular tears usually occur in the lumbar spine or the lower back. In most cases, the tears happen not from the outside in, but from the inside out; they start in the nucleus. When annular tears are minor or just in the beginning stages, they may not cause any discomfort. However, if the tear gets progressively worse, the gel-like fluid in the disc can start to leak out. This may not seem like it can do a lot of damage, but when the fluid hits the spinal nerves, it can cause a lot of pain.
CausesAs mentioned above, a leading cause of annular tears is simply getting older. Vertebral discs lose their durability with age, and the weakened annular fibers can start to tear. Excess body weight can also lead to annular tears, as it can be extremely taxing on the vertebrae and discs. Twisting motions can also put small tears in the annulus fibrosus, especially if they’re coupled with lifting a lot of weight or moving too suddenly. Similarly, individuals who have been in car accidents may also suffer from annular tears.
SymptomsThe one good piece of news is that if you have a minor annular tear, you may not have any symptoms. Unfortunately, if you don’t know you have this condition, you may engage in activity that makes it worse, and then you’ll probably have the lower back pain associated with it. It can often be difficult to find relief from the discomfort from an annular tear; since our back is so integral to just about every movement we make, it’s difficult to alleviate the pain simply by changing positions. And, annular tear pain can sometimes be worse when you’re sitting down.
With more severe annular tears, the symptoms may be worse. The disc can start to bulge, leading to pain, discomfort, tingling, or numbness in the arms and legs.
DiagnosisYou’ll want to see a doctor right away if you’re having recurring back pain so he or she can determine the cause. How will your doctor know if you have an annular tear and not another condition that causes discomfort in the lower back, such as spinal stenosis or facet joint syndrome? There are a few different diagnostic tools available.
An MRI is often a good way to diagnose annular tears, and this may be the first thing your doctor does. However, not all annular tears will be picked up by an MRI, and so your doctor may try a CT discogram. In this procedure, a liquid dye is injected into the disc and observed on a CT scan. The dye will contrast with the disc, and any tears, however small, can be spotted.
Treatment OptionsBecause the annulus fibrosus has such a limited blood supply (a necessary component for the body to repair itself), annular tears can take quite a long time to heal on its own — 18 months to two years. The majority of doctors will start with a conservative approach to treatment, prescribing anti-inflammatory medication to relieve the pressure and possibly steroid injections to alleviate the pain. Regular chiropractic treatments, spinal traction therapy, and physical therapy can also bring relief to individuals suffering from annular tears.
If these conservative treatments are not effective, then surgical treatment may be necessary. Annular tears can be sealed off with a laser procedure to prevent any further injury. Or, a minimally invasive procedure called an endoscopic discectomy can be effective if there’s a painful loose disc fragment in an annular tear. In more severe cases, disc replacement or spinal fusion surgery can replace a damaged disc. There are also some highly advanced treatment options that are in development. For example, using a patient’s stem cells to regenerate their annular fibers. However, these treatments are only used on a case by case basis.
If you are experiencing back pain that isn’t getting better with rest and a decrease in activity, then you’ll want to see your doctor. Severe annular tears, when left untreated, can lead to more painful conditions, such as a herniated disc. A good treatment plan can relieve your discomfort, return you to your preferred level of activity, and keep your back healthy and pain-free.