An annular tear describes a hole in the outer disc wall, called the annulus fibrosus. This protective enclosure is made up of many interwoven layers of cells and is very strong and durable. However, due to disc injury, or spinal degeneration, the outer wall can become compromised, creating a bulging disc, or tear, creating a ruptured disc.
Annular injury is the subject of much study in the dorsalgia sector of medicine and the facts about disc tears might surprise many of you currently reading this essay. This article will focus on what happens when the outer disc wall develops a hole.
A torn annulus fibrosus sounds very bad, especially when the inner disc core, called the nucleus pulposus, leaks out of the disc structure. This event is called a ruptured disc, but can be further classified as an extruded disc or sequestered disc.
Typically, the hole in the annulus must be somewhat large in order for a significant amount of nucleus material to spill out. Small rips and tears in the outer disc wall can also result, but do not allow the nucleus to leave the core of the disc.
Annulus tears are not inherently painful unto themselves, since the disc structure has no blood supply or nerve endings and the outer disc wall is not sensitive to pressure or trauma. An exception to this rule may occur if an annular hole appears on or near the areas that attach the disc to the vertebrae above and below. These cartilaginous endplates do contain tiny nerves and tears in these areas might create what some doctors call discogenic pain.
Any considerable trauma to a spinal disc can compromise the structural integrity of the annulus fibrosus. This is especially true for targeted and focused damage to a small spinal region, typical in cases of sports injury or car accidents.
Sometimes, trauma might cause a disc to simply bulge and no annular hole is enacted. Other times, the annulus might crack slightly, creating a small tear, but without disc nucleus migration. The annulus might rip wide open, creating a large hole which allows for the slow, but steady leaking of the nucleus pulpous from the disc structure over days, weeks or months. In the most traumatic of cases, the disc might actually rupture spontaneously and sometimes under great pressure, causing the nucleus to immediately be ejected completely from the disc.
Normal and expected spinal degeneration also can cause the outer disc wall to develop small holes. These holes typically widen and lengthen as time goes on, allowing the nucleus to slowly migrate from the disc.
Ruptured discs, due to non-traumatic degeneration, are not generally symptomatic and typically do not create any particular problems in the spinal anatomy, especially when compared to trauma-induced extrusions.
Discovering that you have a ripped disc in your spine can be a frightening experience. The nocebo effect of this diagnosis can be strong and may enact symptoms when none would otherwise be present, as well as worsen and perpetuate existing pain syndromes in the back.
It is vital to understand that a tear in the annulus does not have to be a major health issue, since every incidence demonstrates a unique symptomatic expression. In fact, some annulus tears can actually help to resolve pain from a large bulging disc which may be placing pressure on some neurological structure, such as a nerve root or the actual spinal cord itself.
In these cases, the tear allows pressurized nucleus material to escape, reducing the bulge and decompressing the nerve tissue. Over time, these ruptures often calcify, stabilizing the damaged intervertebral level and relieving any minor pain which may remain.