What is an annular fissure?
If you were to look at a picture or x-ray of the spine, you would see that between each vertebra is square piece of tissue called you disc. This little square is a natural shock absorber that helps to limit the stresses that occur to the spine when you twist, lift, bend etc… The inside of this little square is filled with a gelatinous material (called nucleus pulposus) that flexes and stretches as the body moves. Think of this little square as a doughnut and the nucleus pulposus is the jelly. This jelly is surrounded by a hard coating of protective thick material that is called the annulus which you can relate to as the outside covering of the doughnut. The annulus (outside of the doughnut) has nerve fibers but unfortunately no blood supply (“avascular”), which is why injuries to the disc are very difficult to heal, much less treat.
The outer edge of the annulus, or the “outside of this doughnut,” is filled with blood vessels and nerves. As you get older, that inner gelatinous material “the jelly inside the doughnut” can dry out and eventually caused a condition called “degenerative disc disease.” This is kind of like if you sat on a doughnut with no jelly inside. This nucleus pulposus diminishes inside the disc, causing the vertebrae to move closer together. Because the jelly is what separates the vertebra, This disease causes the nerves to come closer together.
Actions that we do everyday such as twisting, bending and heavy lifting put pressure on the outer rings of the annulus (outside of the doughnut) and can make them weak. The fiber in the outer ring can actually rip or tear from the stress, creating a tremendous amount of pain.
The pain from an Annular Fissure is also referred to as an Internal Disc Disruption. It comes from the gelatinous material (jelly on the inside) on the inside touching the pain-carrying nerve-fibers on the outer edge of the annulus. When the inner material reaches those nerve centers, it causes a tremendous amount of pain. If the tear is big enough that the nucleus pulposus reaches the outside of the disc, that is called a disc herniation. This can cause many symptoms in the back or in the leg. If this jelly is touching the nerves in the lower back, it can affect the legs and is called Sciatica. If the jelly is touching the nerves in the neck it is called Cervical Radiculopathy.
What is the cause of annular fissures?
Trauma and degeneration can cause annular tearing. Just sitting and twisting everyday can call small tears. Certain exercise or heavy labor may also contribute greatly to these tears.
Types of tears or fissures:
The three main types of annular fissures are listed below in order of progression:
- The rim lesion – A horizontal tear of the outer annular fibers of the disc which are often associated with bone spurs.
- The concentric tear – The splitting of the lamellae of the annulus in a circumferential direction. Trauma, and not aging or degeneration is the major cause of this type or tear.
The radial tear – A horizontally oriented tear that goes from the inner nucleus pulposus through the entire outer region of the disc. These are significantly associated with the aging process and disc degeneration.
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Spinal Decompression Therapy and Annular Fissures
Spinal Decompression Therapy that we offer at the office have a computer that controls the “distraction force” and the spine is slowly stretched to provide gentle and painless decompression of the “jammed” spinal joints and discs.
This “separation” creates a “sucking” vacuum that directs much-needed nutrients, oxygen and fluids into the injured annular fissure (outside of the doughnut) and nucleus propulsus (the inside of the doughnut which is avascular as explained earlier). This can begin the healing process. In essence, the interior of the disc receives the hydration and nutrients it needs to combat the drying out process that takes place in your nucleus pulposus (inner part of the doughnut) and could lead to an annular fissure ( a tear in the outer part of the doughnut).
If you’ve been told or read your MRI/CT Scan and been told you have an “annular fissure” or a disc “protrustion”, “herniation” or “bulge” and it is has been left untreated, Spinal Decompression Therapy can help. Of course, we need to make sure you are an appropriate candidate for the non-invasive procedure. If you have found that other treatments have not helped, it is time to try Spinal Decompression Therapy. It may be just the thing to get you back on your feet and our office would love to help you with that ASAP!
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