Annular Fissure Causes and Treatment

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An annular fissure is a type of discogenic condition that affects the spine. It usually occurs when the fibers that make up the tough outer covering of the intervertebral disc either break or separate. Collectively, these fibers are known as the annulus fibrosus.

An annular fissure is also called an annular tear, although there are differences between the two terms. It is commonly a wear-and-tear condition rather than due to trauma, and you can take steps to prevent it.

Activities to Help Prevent Annular Fissures
Verywell / Jessica Olah

Overview

The annulus consists of several concentric layers of tough fibers (the material they are made of is called fibrocartilage) that surround, contain and protect the soft, liquid nucleus located inside the disc. The nucleus is a shock absorber; it buffers the weight of the body as it impacts the spinal joints when you sit, stand, or move. It also helps maintain the integrity of the intervertebral joint by supporting the space between the two vertebrae that comprise it.

The layers of the annulus fibrosus are oriented obliquely to one another. In other words, they criss-cross each other and, by doing so, provide scaffolding and support. This design makes the covering of the disc strong enough to contain the liquid nucleus material within. Such strength allows the disc to buffer the jolts and jars that tend to arise when you move your spine.

When an annular tear or an annular fissure occurs, the fibers either separate from one another or are severed from their place of insertion on the nearby spinal bone. A tear may also be seen as a break in the fibers of one or more of the layers.

Causes

An "annular tear" is not a standard term doctors use to describe or diagnose this condition. The reason is that the word "tear" suggests that some type of trauma has lead to the separation or break in the fibers. While an annular tear can be due to a one-off injury, more often long-term wear-and-tear is the culprit.

In fact, most of the time, tears are a result of age-related degenerative changes that take place in the disc. These types of changes can and do lead to further degeneration in other areas of the spine as well.

This means that wear and tear as a cause of annular fissure is, to a great extent, about the day in and day out habits of living—the way you sit, stand, walk, climb stairs, and do other routine movements—that you may have stopped paying attention to and are likely perform without thinking.

Symptoms

Symptoms of an annular fissure or tear range from no symptoms at all, to those similar to a herniated disc. The latter may include pain, numbness, weakness and/or electrical sensations that travel down one leg or arm. Studies have also shown that annular tears and herniated discs can often go unnoticed with few, if any, overt symptoms.

Treatment

Conservative treatment for an annular tear or fissure is generally sufficient to keep the pain and other symptoms at bay. These may include pain medication, either over the counter or by prescription, and/or physical therapy. Physical therapy treatment may include exercises, traction and more.

Should these measures fail to relieve your pain, your doctor may suggest a steroid injection to reduce inflammation and pain. In severe cases, surgery may be explored, including disc replacement surgery.

On its own, the presence of an annular tear is not an indication of disc replacement surgery. It is only when there are degenerative changes in the vertebral disc that surgery may be explored.

Prevention

A lack of attention to the way in which we perform our everyday movements may, over time, set the stage for an annular tear. If correcting your daily movement and posture habits for the prevention of annular tear seems like a mountain to climb, there's good news.

With a bit of effort, the poor posture and less than ideal body mechanics that may have led to the tear in the first place can, in many circumstances, be reversed. But it takes effort and is not a quick fix, as surgery might be. Instead, the idea is to improve joint and overall body alignment, which may, in turn, help you prevent and/or manage an annular tear.

What activities could help you do this? You might try yoga, tai chi, pilates classes, strength training, Feldenkrais Method, Alexander Technique and/or somatics. Each of these systems in some way works towards muscle balance and joint alignment, key prevention strategies employed by many physical therapists when they work with their spine patients.

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Article Sources

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  2. Sharma A, Pilgram T, Wippold FJ. Association between annular tears and disk degeneration: a longitudinal study. Am J Neuroradiol. 2009 Mar;30(3):500-6. doi:10.3174/ajnr.A1411

  3. Yue JJ, Telles C, Schlösser TP, Hermenau S, Ramachandran R, Long WD. Do presence and location of annular tear influence clinical outcome after lumbar total disc arthroplasty? A prospective 1-year follow-up study. Int J Spine Surg. 2012;6:13-7. doi:10.1016/j.ijsp.2011.09.001

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