Annular Fissure

Annular fissure
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What is an Annular Fissure?

An annular fissure is a condition that affects intervertebral discs.  Most of the time a fissure is caused by degenerative changes in the spine, including age-related drying out of the discs, but it can also be brought about by trauma.

Learn Your Anatomy:  Annulus Fibrosis

Dr. Jacob Amrani of the Spine Doctor website reported that one study found fissures to be present in nearly all degenerated discs, and another found at least one small fissure to be present in any MRI showing that the disc is dehydrated.

In an annular fissure the outer part of the disc, which is made of strong fibers arranged in concentric layers, begin to fray, break or separate from the bone to which they are attached. 

Related:  What is an Annular Tear?

Does Annular Fissure Cause Pain?

While an annular fissure may cause pain, it doesn’t always do so.  In fact, a study done by Brinjiki, et.al. published in the April 2015 issue of the American Journal of Neuroradiology found that degeneration could be seen in a “high proportion” of  spinal MRIs of people who did not report symptoms.  The researchers also found that the older the patient was, the more that degenerative spinal changes were evident on their films.

You might think of an annular fissure as loss of integrity in the outer covering of the spinal disc. It’s not a herniation, but it may lead to one if the inner contents of the disc move through the gap made by separation of fibers, and begin to press on a nearby spinal nerve root.

  In this case you may feel pain, pins and needles, electrical sensations or experience weakness or numbness going down one leg (often referred to as sciatica,) or down one arm.

Related:  5 Tips for Preventing Spinal Stenosis

Annular Fissure Diagnostic Procedures

Getting an annular fissure diagnosed involves a medical history, physical examination and diagnostic tests.

 (Your doctor may prescribe pain medication and physical therapy before trying the tests) 

As far as these tests go, they may include an x-ray, MRI, CT scan and/or discography, including provocation discography where a contrast dye is injected to purposely elicit your pain.  If you feel pain in the area where they dye is injected, your doctor may confirm an annular fissure  After your provocative discography, there may be other tests to further hone and describe the affected area.

Related:  About Discogram Tests

Treatment for Annular Fissure

Bao-Gan Peng reports in his article for the 2013 issue of the World Journal of Orthopedics, entitled "Pathophysiology, diagnosis and treatment of discogenic low back pain," that there’s little consensus among doctors and therapists as to the best way to treat a fissure. 

Some doctors routinely prescribe pain medications and muscle relaxers, although, the author says, “the evidence for their efficacy is not compelling.” He says that while conservative treatments such as physical therapy, spinal manipulation (generally a chiropractic adjustment) and back school is used a lot, research has not determined if these therapies are useful for long term abatement of symptoms.

  For low back fissures, he does report on studies that found the McKenzie method (basically a clinical exercise program developed by a physical therapist that has been used all over the word for decades)  is slightly more effective than an adjustment of the lumbar spine, and equal to low back strengthening exercises.

Sources:

Amrani, J. Disc Tear (Annular Tear) Spine Doctor website. Accessed Dec 2015.

Bao-Gan Peng. Pathophysiology, diagnosis, and treatment of discogenic low back pain. World J Orthop. 2013 Apr 18; 4(2): 42–52.

Brinjiki, W., Luetmer, P.H., Comstock, B. Bresnahan, B.W., Chen, L.E. Deyo, R.A., Halabi, S., Turner, J.A., Avins, A.L., James, K., Wald, J.T., Kallmes, D.F., Jarvik, J.G. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173.

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