Annular Tears and Discogenic Low Back Pain

Copyright © 2008 Spine Care Hong Kong

SPINE CARE HONG KONG

ACCURATE DIAGNOSIS, STRUCTURED TREATMENT

The intervertebral disc is composed of a gel filled nucleus and an outer annular fibrous layer. The disc has several functions:

It allows for movement of the spine

It acts as a shock absorber.

A normal disc is subject to wear and tear. If a radial fissure develops then these may become painful as these tears allow the nuclear contents to come into contact with the immune system and a chemical radiculitis may ensue. This is also known as discogenic type of back pain. Symptoms are very similar to those obtained after an acute disc prolapsed with mechanical compression of the nerve root except in this case the irritation is mainly chemical, mediated by various cytokines:

In many ways it is analogous to an automobile tyre. As long as the disc remains pressurized it remains normal but as soon as it depressurizes then problems may arise with increased shear stresses developing on the side walls, just as one sees when a car tyre runs flat and fails catastrophically:

DIAGNOSIS OF ANNULAR TEARS

This may be accomplished by several means, most commonly:

MRI to look for hyperintense zones (HIZ) on T2 weighted images

DISCOGRAPHY to look for contrast leakage and concordant pain

DISCOGRAPHY

 

CASE ILLUSTRATION

34 year old male

Severe Low Back Pain after a lifting injury