Annular Tears

What Are Annular Tears?

Diagram showing an annular tear in spine

Your spine is comprised of vertebrae. In between each vertebrae are discs thatĀ serve as cushions or shock-absorbers when there is movement along the spine.Ā Each disc looks like a jelly donut. They have an outer wall (known as the annulus fibrosus) and an inner core (called the nucleus pulposus).

Over time, the discs in the spine wear out. They become brittle, weak and lose their elasticity in the process. When combined with other factors applying pressure on the discs, tears in the outer wall can form.

This is what we call an annular tear and there areĀ three different types:

  • Concentric Tears ā€“ A tear occurs in the layers of the outer wall (annulus fibrosus) circumferentially, causing the layers to fully or partially separate.
  • Peripheral Tears ā€“ A tear occurs in the outer fibres of the outer wall. This is often caused by an injury since the tear doesnā€™t come from the inner layer. However, it may eventually cause the inside to deteriorate as well.
  • Radial tears ā€“ A tear occurs first in the inner layer of the disc and gradually tear through the outer layer. This condition can eventually involve a herniated disc condition if the inner core (nucleus pulposus) pushes out of the outer wall.

Types of Annular Tears by location:

Ā 

What Causes An Annular Tear?

The natural process of aging is the most common cause of annular tears, specifically radial tears. Overtime, constant pressure from the bodyā€™s weight and lack of nutrients cause deterioration in the discs of the spine. They become thin and lose water content, eventually becoming brittle and weak. Radial tears can also be caused by spinal trauma, which is the cause for concentric and peripheral tears. Spinal trauma is usually caused by high impact sports such as football, lifting heavy objects or significant trauma events like a car accident.Ā 

What Are The Symptoms of an Annular Tear?

The symptoms caused by an annular tear usually include the following:

  • Chronic Pain
  • Numbness
  • Localized pain
  • Tingling
  • Weakness

Most annular tears develop in the Lumbar section of the spine because it is responsible for supporting the upper body weight. The symptoms will vary depending on the location of disc affected. One of the largest nerves that can be affected in the Lumbar section is the sciatic nerve. Hence, the symptom is known as Sciatica.

Here’s a breakdown of annular tear symptoms based on location along the spine:

  1. L1 ā€” Numbness and localized pain in the thigh or groin area
  2. L2 ā€” Numbness and localized pain in the thigh; Weakness in the hip flexor;
  3. L3 ā€” Loss of patellar reflex; Numbness and localized pain in the thighs; quadriceps
  4. L4 ā€” Numbness or loss of feeling in the feet; diminished patellar tendon reflex; loss of strength of quadriceps weakness; localized pain in legs
  5. L5 ā€” Numbness in the feet or toes; loss of strength in the hips and legs

Are You At Risk for an Annular Tear?

Aging is a strong indicator of your risk, so unfortunately this is an injury that we are all at risk for.Ā Constant wear and tear eventually causes the disks to deteriorate. Aging aside, there are several other factors that increase your risk of developing an annular tear:

  • Heavy activities ā€“ Activities like high-impact sports will increase the chances of a spinal trauma. Also, jobs that involve constant lifting and bending increase chances of developing chronic injuries. Both of which can eventually result to an annular tear.
  • Unhealthy weight ā€“ This refers more to obesity or abnormal weight gain. The spine is primarily responsible for supporting the bodyā€™s weight particularly in the upper region. Gaining weight will only increase the pressure on the spine. As the discs deteriorate over time, added pressure will only increase the risk of developing an annular tear in the discs.

How Do You Prevent Annular Tears in Your Back?

Although tears are mostly caused by aging and is likely to develop overtime, there are several things you can do to lower your risk and prevent back injury.Ā 

Stop Smoking

Smoking releases toxins into the body that impede theĀ nutrient cycle of the discs in the spine. Cutting off their nutrient supply like this will increase the vulnerability of the discs. If you quit smoking, the normal circulation of nutrients can return, and the health of your discs can even be strengthened.Ā 

Maintain a Healthy Weight

Since being overweight is a risk factors, we always recommend diet and exercise to maintain a . The added weight increases compression of the spine that can contribute to an annular tear occurring in the disc. Hence, avoiding those unhealthy pounds will prevent increasing the development of an annular tear.

Proper Posture

Proper posture assists in proper weight distribution. The spine is primarily responsible for supporting the bodyā€™s weight and ultimately, contribute pressure to the discs that lie in between vertebrae. Practicing proper posture will help minimize pressure on the discs and delay the development of an annular tear.

Exercising and Stretching

Exercising and stretching can strengthen core muscles and remove unwanted pressure form the discs in the spine. It allows spine decompression to relieve the spine from the constant strain itā€™s in.

These are simple prevention methods to help keep the spine healthy and prevent degenerative diseases. While there is no way to completely prevent annular tears (can’t stop the aging process), these these tips can help prevent early occurrences.

Treatments for Annular Tears in Florida

The treatment for an annular tear does not immediately result to a surgery except in severe cases such as loss of control on bowel movement. Usually, physicians will prescribe certain medications to help ease the symptoms caused by this disease. The following are common medications prescribed by doctors:

Non-Steroidal Anti-Inflammatory Drugs

These are over-the-counter medicines administered to reduce pain and other symptoms, i.e. ibuprofen and aspirin. However, those with cardiovascular or gastrointestinal conditions in their medical history will not be advised to take these medicines

Narcotic Drugs

When over-the-counter medicines donā€™t work, these drugs can address pain and other excruciating symptoms. They are however administered with a doctorā€™s prescription since these can become highly addicting.

These are the most common medication used to treat the symptoms associated with the annular tear. However, if further damage happens to the disc such as herniation or bulging, it can result to inflaming nearby spinal nerves. This can cause even more painful symptoms and will need more intensive medication.

Selective Nerve Root Block Injections (SNRB)

Selective nerve root block injections (SNRB)Ā contain a steroid and an anesthetic which ease inflammation from the affected nerve. This medication also helps treat severe pain.

Epidural Steroid Injections

Epidural steroid injections also contain a corticosteroid, and an anesthetic. This helps reduce the inflammation of the pinched nerve and block all other nerve pain. The numbing sensation is reported to last only for about four to eight hours while the steroid waits for up to two to three days before any pain relief is experienced.

Exercise Tips for Annular Tears

Aside from medication, exercise is also a treatment for an annular tear. While rest is important once the symptoms start to become more intense, exercise is just as important to keep the spine healthy and strong. They key is avoiding even further injury when exercising. Hence it is best to have a physician assist the patient in knowing which exercises are suitable for the given condition.

A daily workout will involve stretching the spine and the muscles around it. Stretching will usually be done before the actual exercise provided that the exercise was approved by a doctor. Stretches can include pelvic lifts and others of the like that can decompress the spine and remove pressure from the discs.

Exercise can then include walking as it is quite easy to do having no need for any kind of equipment. It can easily be weaved through oneā€™s daily routine such as taking the stairs where possible, walking to work or other the grocery store again if at all possible. Other low-impact exercises include biking, swimming and doing yoga.

Conservative Treatment Options in Florida

Patients are usually recommended to undergo conservative treatments instead of an immediate surgery. The treatments are meant to reduce the pressure on the spine so the discs can eventually heal. This helps the disc to realign with the spinal column and free the pinched nerve.

It is often combined with medications as mentioned in the medications for annular tear or with other conservative treatments to increase the healing process. Although there remains further study to be done regarding the safety and efficiency of these treatments, they can be effective in most cases where the annular tear is not severe. Here are following examples:

  • Dietary supplements
  • Herbal medicines
  • Massage therapy
  • Yoga
  • Acupuncture

Surgery For An Annular Tear?

There are two kinds of surgery that can be done with severe cases of annular tear. Usually, surgery is only considered after conservative treatments have failed. Normally, 90% of those who suffer annular tear do not need surgery. The traditional surgery is an open back surgery and the other, less-invasive is the minimally-invasive surgery.

Open Spine Surgery

This is the more traditional surgery called the open spine surgery. The surgery involves large incisions in the abdomen, neck or back. The incision is about six to eight inches that cuts through muscles and tissues that surround the spine to get to the infected area of the spinal column.

Minimally Invasive Spine Surgery (MISS)

Unlike the open spine surgery, MISS only requires a small incision in the neck or back. Then, multiple tubes are inserted careful not to affect the muscle and tissues but to softly push them aside. These tubes serve as funnel through which surgical tools and a camera are used to access the affected disc. Unlike open back surgery, the surgeonā€™s visual of the spine structure comes through the camera.

Recovery Time for Spine Surgery

The recovery process is different for every person. The healing process could very well take weeks to years. However, there are steps to ensure a healthy recovery and to manage the symptoms.

The physician will give clear instructions on the recovery stage. Follow the physicianā€™s words to the letter. It could include therapy or exercises. This will help maintain good circulation while the disc is healing. Remember that recovery after surgery can take time. This means that according to the physicianā€™s instructions, one may need to take substantial time off from work. Even if patients feels like theyā€™ve recovered, they shouldnā€™t push their bodyā€™s limits just yet.

One should however work to stay active. Stiff joints, weakened muscles and an inefficient immune system will render the spine weaker. They key is to know which exercises are right so that at the same time no further injuries are incurred in the spine. Some of the low impact exercises can include:

  • Walking or hiking
  • Swimming
  • Using an elliptical trainer
  • Strengthening core muscles

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