What is an Annular Tear?
An annular tear develops in the annulus of an intervertebral disc. They develop gradually as we age. Tiny tears and fissures can develop and spread through the soft tissue of the nucleus pulposus. Eventually, the tears will irritate the outer third of the disc which contains several nerves. The pain may at first be acute and gradually become chronic, and quite irritating. An annular tear can be concentric, transverse, or radial and can involve all layers of the annulus.
Your vertebral discs serve as shock absorbers, cushioning the spinal column. Not surprisingly, losing the structural support of a disc will cause pain which will intensify with movement. Occasionally, the annular tear will stimulate the transversing nerve and cause a form of pain called radiculopathy which is felt in your arms and legs.
At times, a fissure can cause an extrusion or herniation of the annulus fibrosus, a sturdy ring of fibers that contains the soft center. A herniation can place significant pressure on the nerves adjacent to the vertebrae. If herniation has occurred, you can be sure that an annular tear or an annular fissure was present.
Many annular tears will not cause any pain and will heal on their own, but some tears can be quite painful especially if they are located in the outer third of the disc’s annular ring.
Causes of Annular Tears
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. For patients over sixty, annular tears can also be an early sign of degenerative disc disease caused by osteoarthritis.
Annular Tear Treatments
Because 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 minimally invasive procedure called an endoscopic discectomy which can be effective if there’s a painful loose disc fragment in an annular tear. In more severe cases, Artificial Disc Replacement or spinal fusion surgery can replace a damaged disc.