Annular Fissure - What is it and What Should You Do?

A good view of the annulus fibrosus of the disc.
A good view of the annulus fibrosus of the disc. BSIP/UIG/Universal Images Group/Getty Images

Annular fissure is a type of discogenic condition that affects the spine. It usually occurs when the fibers that make up the tough, outer covering of the intervertebral disc (called the annulus fibrosus ) either break or separate.

Annular fissure is also called annular tear, although there are differences between the two terms. (This is discussed in more detail below.)

Annular Fissure or Annular Tear - What's in a Name?

Note that, "annular tear" is not a standard term doctors use to describe or diagnose this condition.

The reason is that the word "tear" suggests that some type of trauma lead to the separation or break in the fibers. 

While an annular tear can be due to a one-off injury, more often long term wear and tear is the culprit. In fact, most of the time, tears are a result of age-related degenerative changes that take place in the disc and spine. These types of changes can and do lead to further degeneration in other areas of the spinal joint, by the way.

This means that wear and tear as a cause of annular fissure is, to a great extent, about those day in and day out habits of living - the way you sit, stand, walk, climb stairs, etc. - that you may have stopped paying attention to, and that you do auto-pilot (so to speak.) When we stop paying attention to the way in which we perform movement, less than ideal habits can, over time, set the stage for an annular tear.

If correcting your habits so that you can prevent an annular tear seems like a mountain to climb, I have good new for you: With a bit of effort, poor posture, body mechanics and muscle imbalance (generally the things that make up subtle, but long term spine destructing habits) can largely be corrected.

In other words, working towards a more balanced posture and body alignment may help you prevent and/or manage your risk for an annular fissure or tear. Things you could try that may help include yoga, Tai Chi or Pilates classes,  strength training using good form (which is imperative, otherwise strength training may actually contribute to spine problems in some cases) and/or trying movement education methods such as Feldenkrais, Thomas Hanna Somatics or the Alexander Technique.

How an Annular Tear Happens

The annulus consists of several concentric layers of tough fibers (the material they are made of is called fibrocartilage) that surround, contain and protect the soft, liquid nucleus that’s located inside the disc. The nucleus is a shock absorber (which means it’s a pain reliever, too); it buffers the weight of the body as it impacts the joint when you sit, stand or move. It also helps maintain the integrity of the intervertebral joint by supporting the space between the two vertebra that comprise it.

The layers of the annulus fibrosus  are oriented obliquely to one another; in other words, they criss-cross one another as a providing scaffolding. This makes the outer covering of the disc very strong; it also keeps the liquid nucleus material contained enabling the disc to do its job of buffering the jolts and jars that arise when you move your spine.

But when an annular tear or annular fissure does occur, the fibers either separate from one another or are severed from their place of insertion on the nearby spinal bone. A tear may also be seen as break through the fibers of one or more of the layers.

Symptoms of an annular tear or fissure range from no symptoms to those similar to a herniated discs, which includes pain, numbness, weakness and/or electrical sensations that travel down one leg or arm.

Treatment for an Annular Tear or Annular Fissure

Conservative treatment for an annular tear or fissure is generally sufficient to keep the pain and other symptoms at bay. Such treatments may include pain medication (over the counter or by prescription) and/or physical therapy. Physical therapy treatment may include exercises, traction and more.

Should these measures fail to relieve your pain, your doctor may suggest a steroid or other type of injection, or possibly minimally invasive spine surgery.

Sources:

Fardon, D.F., Williams, A.L., Dohring, E.J., Murtagh, F.R., Rothman, Gabriel, S.L., Sze, G.K. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J. 2014 Nov 1;14(11):2525-45. doi: 10.1016/j.spinee.2014.04.022. Epub 2014 Apr 24.

Jones, Jeremy, Gallard, Frank, A., et. al. Annular fissure. Radiopaedia.org website.

Kapandji, I.A. The Physiology of the Joints. Churchill Livingstone. 1974. New York.

Lumbar Discogenic Pain. Physiopedia website. Accessed Dec 2015

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