Annular Tear – What Does It Mean?

Annular tears occur from the nucleus of the spinal disc. Enzymes, contained in the gel-like substance of the nucleus of a disc, leak out through the annulus and reach the nerve endings. This causes a strong inflammatory chemical reaction and burning pain. These tears are caused by aging, sports, obesity, degeneration of the spine, and injury. Most tears heal by themselves over several months but heavy lifting must be avoided. With some avoidance and self-treatment most never need surgery. Over time scar tissue forms in the outer layers of the annulus, forming a plug through which the nucleus material cannot leak. They do frequently reoccur.

Patients frequently ask “what is the difference between a disc tear and a disc herniation”. The difference is simple. A tear is a tear in the disc (Figure 2) and a herniated disc is a bulge in the disc (Figure 4). The tear will leak enzymes and irritate the nerve root, a herniation will produce compression of the nerve root.

Treatment: Assuming that the patient isn’t experiencing debilitating or rapidly worsening symptoms, annular tear treatment usually begins with low-impact exercises, hot or cold compresses, over-the-counter or prescription pain medication, and limited rest. Again, heavy lifting will need to be avoided while the disc heals.

ODG – Return-To-Work “Best Practice” Guidelines: Mild cases with back pain, avoid strenuous activity: 0 days. Medical treatment, clerical/modified work: 20 days. Medical treatment, manual/heavy manual work: 40 days.