What is an annular tear? I'm Dr. John Shim, and today I'd like to discuss a
very intimidating sounding term. Many of my patients have had episodes of neck or
back pain, and during the course of evaluation a test called an MRI was
obtained. Oftentimes, the studies identify things like bulges and herniations. If you
have watched my prior videos you'll know that it's a very common finding on MRIs,
and whether you do or do not have pain you - can't find them. What scares many however
is the term "annular tear." It sounds very painful. It
sounds like a big problem. The truth is it may or may not be an issue. Let me
explain. To summarize basic disc anatomy there are two main components. There's a
softer inside of the disc called nucleus. It's full of water, it gives the shock
absorbing properties of the disc. There's also the outer component of the disc
called the annulus. It's a very tough ropey structure that holds the nucleus
into the center of the disc. If you have a disc herniation, by definition the
nucleus material has to come out of its normal central location, and through the
annulus or a break through the top or bottom of the disc bone interface called
the end plate. This break in the annulus can be called a "annular fissure" or the
more scary term is "annular tear." The medical community is still trying to
identify these annular tears through various diagnostic studies. The best way
to identify the breaks is to inject a disc with dye material, and then because
of the break the dye material can be seen escaping a disk on cross-sectional
cat-scan. That is the definitive diagnosis of a break in the annulus. To
do this test, it can be very painful, it is invasive, and unfortunately the latest
information indicates that doing the discogram procedure itself can
potentially lead to accelerated disc degeneration. Yes, this procedure is
called a discogram, and it does remain controversial, and there are concerns
that the procedure itself will cause future degeneration. MRI studies are less
invasive. In the 1990's as MRI studies were becoming more commonly used
findings towards the edge of the annulus called high intensity zones were
initially thought to indicate new breaks in the annulus or even indicate pain
coming from the annulus. This too became a very controversial issue. In the 1990's
many people had surgery for the so called high intensity zones.
Unfortunately, the results were not as predictable as thought. Now there have
been further studies indicating these high-intensity zones may not in fact
indicate an annular tear. Long term studies of these high-intensity zone
findings found that they may never actually go away. So, there's really no
way to know if these findings demonstrate a new or an acute problem.
From a diagnostic standpoint, in my opinion, there are still too many
unknowns and associated risks to try to identify an annular tear. From my
perspective as a spinal specialist because the fissure in the annulus is
necessary to create a disc it is my opinion that in general if you have a
disc herniation you will likely have an associated annular fissure or tear. The
other possibility of course is a break in the end plate, that allows a central
nucleus to come out of its normal position.
The term "tear" emotionally associates with some sort of traumatic event.
What we know of disc herniations is that they can occur with what sounds like
very trivial motions: sneezing, coughing, bearing down well in the bathroom,
twisting in bed, reaching for an object. These are very trivial appearing motions,
but are associated with herniated disks. While it is true that activities such as
a significant fall, a direct blow, or a car accident can cause herniated disks,
everyday activities of life also are just as likely to cause these
herniations. The more the medical community learns the more we realize
that genetics is playing a significant role in development of disc
abnormalities. In my opinion the term annular tear on MRI study may or may not
have any significant bearing on your current condition.
The term annular tear on MRI is typically associated with the so called
high-intensity zone which we now know may or may not be symptomatic.
In other words, may or may not be the source of your pain. While the term
annular tear sounds scary it may not be the source of any pain. As I stated this
high intensity finding was used as an indication for surgical management in
the past - as of 2019 the finding by itself is no longer an indication for
need for operation. The finding by itself does not make you a quote "candidate for
surgery." If you have an annular tear on your test results do not be scared. Get a
comprehensive second opinion by a spinal specialist. This is Dr. John Shim,
discussing annular tears. I hope this gives you some comfort when you read
that scary testing result. If you find this information helpful - please Sign Up
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