Annular tears most commonly occur in discs that are degenerating or breaking down. In this episode we continue our series on blab titled “What is causing your lower back pain?” We discuss Sheila, a 54 year old office worker who has recently been diagnosed with an annular tear.
The intervertebral disc is comprised of 2 components, the annulus fibrosus and the nucleus pulposus. The annulus is made of tough cartilage and is arranged in concentric rings around the inner nucleus. Its job is to contain the nucleus and to withstand the high compressive forces of the spine. The inner nucleus pulposus is made up of several substances, most importantly proteoglycans and water. Its job is to help spread those compressive forces of the spine over a greater surface area of the vertebra.
A healthy disc absorbs its nutrition from its neighboring vertebra. It needs oxygen, glucose and water to survive. When discs begin to degenerate, they lose their ability to attract oxygen, glucose and water, their cell metabolism begins to slow down and they eventually die. The annular fibers then can no longer withstand the high forces generated in the spine and they can develop tears. The tear can be radially through the layers from the inside out, or concentrically – in between 2 layers. Some tears are symptomatic and produce pain, while others are not painful at all.
In this episode we discuss Sheila. She was recently diagnosed with a radial annular tear. She was experiencing lower back pain. She was a very non-compliant patient, as some are, and did not do what she could to help herself get out of pain. The best clinician in the world will not be able to help you unless you remove the source and cause of the pain.