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Defintion
The annulus is the fibrous ring of the disc structure which surrounds
the centrally located soft nucleus of the disc. The nucleus and annulus
function together to create a pressurized structure that acts as a shock
absorber. The annulus is a ligament and like any ligament in the body
can be torn. Tearing of the annulus can produce pain because the annulus
has pain fibers within its structure. Many episodes of low back pain are
probably tears in the annulus.
Diagnosis
The diagnosis of annular tearing can be made on MRI imaging but the definitive
diagnosis is made on CT-discograms where dye is injected into the nucleus
of the disc leaks out into the torn area of the annulus.
Non-Surgery Treatment
Treatment can consist of time to reduce symptoms, physical therapy, bracing,
medications, etc.
Surgical Treatment
In very selected situations, the symptoms from the annulus may be treated
with intra-discal electrothermal treatment. Occasionally, patients have
enough persistent pain from annular tears and internal disc disruption
to undergo a fusion of the disc space at the level of the tear.
Prognosis
The prognosis of annular tears is generally the prognosis of low back
pain. Annular tears can be the precursor of the herniated disc.
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