The spine is made up of vertebrae and in between individual vertebrae are discs that serve as cushions or shock-absorbers from the movements in the spine. They minimize the friction in between the vertebrae. They look like jelly donuts that contain an outer wall (annulus fibrosus) and an inner core (nucleus pulposus). Eventually these discs wear out with time, they become brittle and weak, losing its elasticity in the process. This including other factors that contribute to the pressure on the discs, can cause the outer wall to tear. This condition in the disc is called Annular Tear. There are different types of Annular Tear and these are the following:
- Concentric Tears – A tear occurs in the layers of the outer wall (annulus fibrosus) circumferentially or causing the layers to either fully or partially separate.
- Peripheral Tears – A tear occurs in the outer fibres of the outer wall (annulus fibrosus). This is often caused by an injury since the tear doesn’t come from the inner layer. However, it may eventually cause the inside to deteriorate as well.
- Radial tears – 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 (annulus fibrosus).
The natural process of aging is a common cause for tears, specifically radial tears. Overtime, the discs in the spine deteriorate from constant pressure from the body’s weight and lack of nutrient. They become thin and lose water content and eventually become 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, or heavy activities form work such as lifting heavy objects.
The symptoms experienced are usually the following:
- Chronic Pain
- Localized pain
Usually, the annular tear develops 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. The following are common symptoms depending on their location:
- L1 — Numbness and localized pain in the thigh or groin area
- L2 — Numbness and localized pain in the thigh; Weakness in the hip flexor;
- L3 — Loss of patellar reflex; Numbness and localized pain in the thighs; quadriceps
- L4 — Numbness or loss of feeling in the feet; diminished patellar tendon reflex; loss of strength of quadriceps weakness; localized pain in legs
- L5 — Numbness in the feet or toes; loss of strength in the hips and legs
The natural process of aging is the most common cause for the development of an annular tear. The constant wear and tear eventually cause the disks to deteriorate. While aging is unavoidable, there plenty of other factors that increase the risk of developing an annular tear. The following risk factors are discussed:
- Aging – The older a person is, the higher the likelihood of an annular tear development. The discs eventually deteriorate. They thin out and lose water content. They become brittle and lose elasticity. All these make it more likely for a tear to develop.
- Heavy activities – Activities that involve high-impact sports will increase the chances of a spinal trauma. Also, jobs that involve constant lifting and bending increase chances of chronic injuries. Both of which can eventually result to an annular tear.
- Unhealthy Weight – This refers more to obesity or abnormal weight gain. The spine is primarily responsible for supporting the body’s weight particularly in the upper region. Increased weight will only increase the pressure on the spine. As the discs are already prone to deteriorate with time, the added pressure will increase the chances of developing an annular tear in the discs.
Although tears are mostly caused by aging and is likely to develop overtime, there are things than one can do to slow down its development. The following are examples of prevention methods:
- Stop Smoking
Basically, smoking impedes the nutrient cycle of the discs in the spine because of the toxins it releases in the body. As the discs are already prone to deteriorate overtime, cutting off its nutrient supply will increase the vulnerability of the discs. Hence, stopping the habit allows the normal circulation to flow, providing the essential nutrients to the spine therefore strengthening the discs to avoid tears from developing much faster
- Maintain a Healthy Weight
Being overweight is one of the risk factors of disc herniation. 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 body’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 it’s in.
These are simple prevention methods to help keep the spine healthy and far from degenerative diseases. It does not however fully impede the development of an annular tear but avoids the early occurrence of it.
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 nedications 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 don’t work, these drugs can address pain and other excruciating symptoms. They are however administered with a doctor’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)
The medication is injected containing a steroid and an anesthetic which eases the inflammation of the affected nerve. This also treats severe pain.
- Epidural steroid injections
Epidural 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.
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 one’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.
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
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 surgery
Unlike the open spine surgery it only makes 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 the open back surgery, the surgeon’s visual of the spine structure comes through the camera.
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 physician’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 physician’s instructions, one may need to take substantial time off from work. Even if patients feels like they’ve recovered, they shouldn’t push their body’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
- Using an elliptical trainer
- Strengthening core muscles