Low back can be excruciating. One’s quality of life and mobility can rapidly decline as the pain escalates. What is an Annular Tear? What are the symptoms of an Annular Tear? What causes an Annular Tear? How do you treat an Annular Tear? Are there natural regenerative treatment options? Let’s dig in.
What Is an Annular Tear?
The disc is an important shock absorber in the spine. There are 7 discs in cervical, 12 in thoracic and 5 in the lumbar region. The disc is sandwiched between the building blocks of the spine called vertebral bodies. There are two principal parts to a disc: the nucleus populous and the annulus (1). The nucleus populous is the center of the disc which has a jelly-like consistency. The annulus is the thick fibrous sidewall that encases the jelly-like center. The annulus consists of fibrocartilage made up of both types 1 and 2 collagen which allows it to withstand significant forces (2). If forces are excessive or repeated over time a tear can occur in the annulus. The annulus is rich in pain fibers, therefore a tear in the annulus can be painful.
There are different types of annular tears based upon their location which include radial, peripheral, concentric, and transverse. MRI is the study of choice. An annular tear, also known as a high-intensity zone is identified on MRI as a bright white signal in the disc as illustrated in the image to the right (3).
What Are the Symptoms of an Annular Tear?
Not all annular tears create pain. The incidence of asymptomatic lumbar annular tears varies from 36- 56% (4). When symptomatic pain is the most common symptom, the degree of pain is often related to the location and size of the tear. Pain is typically localized in the spine and it can be accompanied by muscle spasm and muscle stiffness. If the nerve root is involved radiating pain into the extremity can occur with weakness.
What Causes an Annular Tear?
Annular tears can occur due to many different causes. The disc is an important shock absorber in the spine. High impact activity or repetitive exertional/straining movements puts additional pressure and strain on the disc. This gradual wear and tear can lead to an annular tear. Trauma can also cause an annular tear. A tear in the annulus is important as it weakens the sidewall of the disc. A weakened sidewall can lead to additional disc injuries including disc protrusions or herniations. Repeated injuries can lead to disc degeneration with loss of disc height and its ability to absorb the compressive forces of life.
How Do You Treat an Annular Tear?
Not all annular tears are symptomatic. When tears in the annulus are symptomatic conservative care is the first line of treatment with PT and anti-inflammatory supplements such as fish oil and turmeric. These supplements can reduce inflammation and, therefore, pain.
PT is also useful, as it can strengthen core muscles and improve neutral spinal alignment. If pain persists steroid injections are oftentimes recommended. Although powerful anti-inflammatory agents, steroids are also toxic to orthopedic tissue, which includes the disc (5). They can also inhibit stem cell function and repair, and therefore should be avoided.
Surgery is often recommended when conservative care has failed and pain persists. There are many different types of surgeries. Discectomy is a common surgery for annular tears where a portion of the bulging or injured disc is trimmed (6). This makes little sense as it further weakens the sidewall of the disc. Discectomy compromises the stability of the disc and spine and can accelerate disc degeneration and disc collapse.
Are there natural, regenerative options? Yes!
PRP contains numerous growth factors that can accelerate healing and repair. Vascular endothelial growth factor also known as VEGF is important as it can increase blood flow. Improved blood flow, in turn, can accelerate healing and repair in areas with poor blood flow such a the annulus. At the Centeno-Schultz Clinic, we use a customized PRP that is rich in VEGF to treat symptomatic annular tears. Stem cells are another treatment option. Bone marrow-derived stem cells can be injected directly into the annular tear to increase blood flow and accelerate healing. This is a demanding procedure that takes significant training and a deep understanding of the anatomy, and x-ray images. This is not a procedure that your PCP or orthopedic surgeon can perform.
To learn more about PRP injections and the dangers of steroid injections and disc surgery please watch the video below.
The disc is an important shock absorber. The center of the disc is the nucleus populous whereas the thick outer sidewall is the annulus. The disc absorbs the forces of daily living and as such is susceptible to injury. Tears in the annulus can occur due to a number of reasons which include repetitive wear and tear and trauma. Not all annular tears cause symptoms. When symptomatic the pain is the most common symptom and may be accompanied by muscle spasm and burning pain in the extremity. Annular tears weaken the stability of the disc and predispose it to additional injuries including disc protrusions, disc herniation, and disc degeneration. Steroids injections are toxic and should be avoided. Discectomy is a common surgery that can further destabilize the disc accelerating disc degeneration and collapse. PRP and stem cells have unique regenerative properties which can increase blood flow and healing of annular tears. If you are being held back by ongoing spine pain due to an annular tear please schedule a Telemedicine consult with a board-certified, fellowship-trained physician who can discuss natural, non-surgical treatment options for spine conditions. It is time to free yourself from the limitations imposed by pain.
1.Amin RM, Andrade NS, Neuman BJ. Lumbar Disc Herniation. Curr Rev Musculoskelet Med. 2017;10(4):507-16.
2.Kadow T, Sowa G, Vo N, Kang JD. Molecular basis of intervertebral disc degeneration and herniations: what are the important translational questions. Clin Orthop Relat Res. 2015;473(6):1903-12.
3.Saifuddin A, Mitchell R, Taylor BA. Extradural inflammation associated with annular tears: demonstration with gadolinium-enhanced lumbar spine MRI. Eur Spine J. 1999;8(1):34-9.
4..Yue JJ, Telles C, Schlösser TP, Hermenau S, Ramachandran R, Long WD. Do presence and location of annular tear influence clinical outcome after lumbar total disc arthroplasty? A prospective 1-year follow-up study. Int J Spine Surg. 2012;6:13-7.
5.Wernecke C, Braun HJ, Dragoo JL. The Effect of Intra-articular Corticosteroids on Articular Cartilage: A Systematic Review. Orthop J Sports Med. 2015;3(5):2325967115581163.
6.Nigro L, Landi A, Marotta N, Delfini R. Lumbar Annular Tear in the Absence of Nerve Root Compression: Is Discectomy Useful. J Neurosci Rural Pract. 2016;7(Suppl 1):S126-S128.