Your spinal column is like a stack of blocks connecting your skull to your tailbone. Separating and connecting each bone in this column are intervertebral discs. These discs are layers of cartilage that add a much-needed cushion, allowing your spine to suspend your body, stabilize the body during movement, bear weight and absorb shock impulses. Because of this, these discs are particularly susceptible to increased wear.
Each cushion is made up of two parts: a glutinous center called the nucleus pulposus (nucleus) and a ring of ligament fibers encasing this core called the annulus fibrosus (annulus.) Think of each disc or cushion as a jelly-filled donut with an impenetrable, rubber dough exterior pressurizing the jelly inside. Over time, the ability of the annulus, or dough, to contain the disc’s inner material will become compromised. Annular tears can lead to chronic pain, herniated discs, the onset of disc degeneration, or a marked loss of motion from the stiffening of joints.
Specific causes of annular tears vary, but there is no denying that degenerative disc disease is a fact of life. Intervertebral discs inevitably dry and weaken with age. Sometimes this degenerative process can be considerably quickened by lifestyles that are uncommonly sedentary or uncommonly heavy in labor.
In addition to the natural spinal deterioration that comes with age, an annular tear may also be caused by traumatic injury. A sudden blow or force from high impact sports can exert excess pressure on the spinal column causing the annulus to rip.
Annular tears are often found on the neck and lower back. These areas are where the spine is very flexible but also supports a lot of body weight. There are three basic types of annular tears:
- RADIAL TEARS can lead to chronic pain and disc degeneration. They may be a consequence of a single traumatic event, repetitive trauma, and sometimes even poor genetics. The natural aging process is usually the culprit. Radial tears begin closer to the jelly center of the disc and extend through the outer layer of the annulus. This tear can cause a herniated disc, which happens when the nucleus expels itself through the tear to the outside of the disc itself.
- PERIPHERAL TEARS are horizontal tears that are found in the outer fibers of the annulus and can be caused by trauma, age, or contact with a bone spur. These can lead to the breakdown of an intervertebral disc.
- CONCENTRIC TEARS are identified by a separation or splitting apart of the layers of the annulus fibrosus. These tears between the layers are usually caused by injury, especially torsion overload injuries, like swinging a golf club. This tear does not stimulate severe disc degeneration like the other two, but it does cause biomechanical problems within the disc. Subchondral bone thickening adjacent to the tear ‘stiffens’ the joint. This thickening of the joint causes a marked loss of motion. These tears are not associated with aging or degeneration, for they are seen in equal numbers in both young and old.
Chronic pain, numbness, weakness and tingling in the extremities are all quite common in cases of the nerve root and spinal cord compression. This particular type of pain is known as discogenic pain. It is the pain some people suffer when the inner disc material escapes the disc and seeps into the spinal column. Your resulting pain can range from nonexistent to mild to excruciating; it varies depending on the placement and severity of the annular tear and the sensitivity of the individual.
- Because of the passageway formed by the annular tear, material from the nucleus of the degenerated disc comes into contact with pain-producing nerve endings in the outer annulus, initiating a painful inflammatory process.
- The tear communicates the nucleus to the outer annulus, causing a loss of pressure in the nucleus. This loss of pressure redistributes your axial load (the load that your spine helps support), shifts it from the center of the disc’s nucleus, and dumps it onto the pain fiber on the posterior side of the disc.
Annular tears can occasionally be asymptomatic. Some patients can have annular tears without having any pain at all, especially construction workers and people with similarly arduous work environments.
After a physical assessment, a doctor will try to find the source of your pain using one or more diagnostic tests. An MRI scan is used to look at intervertebral discs, but annular tears may not always be visible. A discography text is performed under x-ray guidance to see if the disc is truly the source of the pain. This type of test enables the doctor to examine the disc and the pain you are experiencing at the same time.
The pain and discomfort accompanying an annular tear can be relieved with conservative treatments like rest, hot/cold therapy, physical therapy, low-impact exercise regimens, and pain relieving or anti-inflammatory medications, both over-the-counter and prescription.
Talking to a doctor or a back specialist to learn about treatments and preventions tailored to your needs is a helpful step to take. Permanent and complete prevention may not be achievable, but there are preventative measures that can help you keep a healthy and strong spine. Adopting these standards will reduce the risk of developing degenerative spine conditions in general. Simple steps like quitting smoking, losing weight, regular stretching and exercise, good posture, and reduced alcohol and caffeine are lifestyle changes that impact your overall health and benefit your spinal health.
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