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Annular tears and herniation size

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:27 AM in Degenerative Disc Disease
I'm reading through all my medical records, and I was wondering whether folks' MRIs ever discuss herniations in terms of millimeters (my MRIs just said minor, moderate, severe) and whether the MRIs ever pointed out annular tears (mine didn't say anything about this). Thanks!


  • was found using a discogram.
  • Thanks! I guess my other question is what test determines reduction in disc height?
  • Also caused loads of pain. I don't have the answer to your disc height question.
  • I had an mri scan, and went for my dicogram but didnt go through with it as they wanted to go in from the side 15-20cms and i just couldnt bring myself to get it done. So my diagnosis was purely on mri (and xray but that doesnt show actual discs) I was told I have a severely degenerated disc and also annular tear and bulge..so it was all found on mri..as for size of bulge, it may say on my report but ive not seen it, just listened to my surgeon telling me.
    I also have another disc that is herniated and 'crushed' from a fracture that i had almost 2 years ago...but nothing is going to be done about that at this stage because it doesnt look as if it is bulging out onto anything to cause pain, even though it hurts! Im getting a tlif fusion done in a months time.

  • i had numerous MRIs Cat Scans, Myleogram and only after two years and many Drs did I finally find my source of pain. Three disc with tears. I had a discectomy and fusion on two levels in Dec. I still have 1 disc with tears but it isnt as bad so I had that one left, but will probably face another fusion in future. Only did 2 levels cause Ortho didnt want to have the chance of non fusion by doing 3. He said that 3 is to risky, so you need a discogram to dissern that they are painful. Hope this helps and anything else, let me know.
  • ok ive got a question....ive got two 2 bulging discs both with tears in them one bulge just says minimal and the other has a measurement 3 by 9 by 7 mm i still dont really know if that is considered large or not. but the bulges are slightly indenting and contouring the thecal sac. anywho i have been in a great deal of pain but my doctor tried telling me that i shouldnt be having pain just with having the tears....but you guys are saying that the tears are whats causing the pain....im confused! im incredibly put off by my doctor saying that i shouldnt be in pain when according to my mri i have alot of problems....i think im just getting brushed off because i am young and before this was in excelent health. :(
  • dilaurodilauro ConnecticutPosts: 9,849
    in having disc problems referred to as: Bulging, Ruptured, or Herniated disc. For ease of you, each of those terms are basically referring to the same problem.

    Look at this post that is under our FAQ

    Disc Terminology

    I have not seen many MRI reports that show the actual sizes of the disc problems, they generally refer them to as

    I cant say for sure, but I believe reading an article that a dics bulg > 6mm is considered something serious
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • thank you for clearing up the bulging, ruptured, herniation thing. i dont know how severe my condition is becuase my doctor keeps telling me that ya ive got 2 bad discs but they arent surgery worthy, thank goodness. but why do i have pain that causes me to have no life whatsoever and last night i woke up with both of my legs completely numb. and all they can do is throw pills at me. it seems like every one of my posts is the same on here i try to be optimistic but im losing faith, i just feel depressed all the time. i go to work or school come home and lay on a heating pad the rest of the day. this is no way to live. i have to plan my day around what will hurt me the most because that means i have to do that activity last. im losing control of my life and my back is now dictating what i do. this is no way to live and for a dr to tell me that it has to get worse before they do anything is beyond me.
  • I have a far small right herniated disc and tear with disc material on the S1 exiting nerve. I have been in pain for this small herniation and anular tear for a year and with little relief. They never used cm or inches how big it is for mine. www.chirogeek.com was helpful for me in defining a few things. Ron the jelly donut is a good description. I want a peanut butter and guava jelly sandwich now! Take care dcGuy. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • You should ak your Dr about having a discogram to dwtermine if the disc are the pain generates. That is what my ortho did. It doesnt matter how big the tear is. My orto said a tear is a tear, small or large they can all be very painful. If your Dr wont help you, its time to get a seocnd opinion. Or at least see a pain Dr to help with you pain. Good Luck.
  • MRIs cannot pick up all tears or even the depth or length of tears. Sometimes they cannot even pick up the degree of herniation. The disc material that leaks out from tears is very irritating to nerves, so even a small tear can make horrible leg pain. The discs themselves have nerves and can cause discogenic pain.

    Discograms are considered the gold standard by the neurosurgical community for nerve root compression and definitive diagnosis.

    Kirstabell-you said they give you meds, but you have had any epidurals? Discs try to heal themselves and if small enough, the steroids can help buy you time for them to heal.

    I also love the www.chirogeeek.com website to explain annular tears. It's interesting to hear from someone else who has medical training what their experience was like.
  • kristabell said:
    ok ive got a question....ive got two 2 bulging discs both with tears in them one bulge just says minimal and the other has a measurement 3 by 9 by 7 mm i still dont really know if that is considered large or not. but the bulges are slightly indenting and contouring the thecal sac. anywho i have been in a great deal of pain but my doctor tried telling me that i shouldnt be having pain just with having the tears....but you guys are saying that the tears are whats causing the pain....im confused! im incredibly put off by my doctor saying that i shouldnt be in pain when according to my mri i have alot of problems....i think im just getting brushed off because i am young and before this was in excelent health. :(
    How old are you? I'm 30 and I was told when I was 18 that I had a tear in one of my disc. I did indeed have some pain but now I have 3 herinated disc with annular tears and DDD real bad they told me my DDD is severe but I went to a doctor to see if I'm a canidate for surgery and he turned me down said I'm a drug user (I controll my pain with Fentanyl 25mcg, Neurtion, Mobic, and Zanaflex, and last my Tramadol for breakthrough pain. I was told I was a drug user OH yeah and I'm over weight. lol I didn't need him to tell me all that I could have had my mother tell me and save my gas and a trip.

    Anyway, I sought out another doctor and he told me that my disc wasn't causing the pain it was my scolisis I have. They don't even look at my MRI's or my CT report. I think they just want to keep some of us in pain until we get to the point where we run to the ER for the pain and can't walk or bed ridden.

    I went back to my Chronic Pain Doc and asked him to refferal me to another doc so he did, Their is a doc in ATL, GA that only operates on spines and nothing else. I had to call my lawyer to get him involved to hurry up my case so I can see him. I'll let you know what the outcome is.

    I would see a Orthropedic Specailist who surgical on Spines only or a Neurogologist.
  • That site is pretty cool I went to it. Tells you all kinds of things. I think I will keep that in my favorites.
  • I also have had 2 years of testing with numerous md's diagnostic testing, injections, mri's, PM doc's, finally have a diagnosis after a discogram. Basically i have 3 annular tears,starting at L2-L3, toL5-S1, grade DDD3-4.The worst is L4-L5 DDD grade 4. That is the atypical symptom producer and therefore took 2 years to diagnose. The discogram finally gave me what i needed. I will see a neurosurgeon next week......then who knows. Does anyone have any ideas about treatment? I have extreme burn pain in rt. buttock, all the time. Any ideas and comments would help. Thanks to all who take time to read. Yeah---I am not crazy--I have reason for all this pain.
  • Hey there.

    I'm no doctor but it sounds like sciatica to me. You'll find that on this website there's an interactive video you should watch for siatica and may be quite helpful for you to see if it's sounds like what you've been experiencing.

    Good luck and don't give up!
  • dcguy, I suffered for years with lower back pain. No doctor in my town found anything wrong. (There were no parts broken off and floating around on the x-ray, so to them, I didn't have a problem). I was beginning to think the problem was "all in my head". I searched the web for months and found a doctor in Atlanta, who did a discogram. The discogram showed that all the lumbar discs were torn and the nucleus had leaked out. It was a few more years before I found out that the nucleus is a protein substance that irritates nerve endings, thus the reason for the pain in my back and legs.

    My lumbar pain is gone, but now I have a bone spur growing into my spinal cord and a herniated disc in my neck. Also fibromyalgia.

    I hope you get some relief soon. I know how frustrating it is to live with constant pain.


  • I also have a myriad of chronic and acute lower back pain and siatica. I've now reached the point that I need a Discogram and an educated specialist to interpret,diagnose and treat my particular problems.

    I have read several post that discuss good Dr.'s ,for these situations, who work in Atlanta,Ga. I live in nearby Birmingham, Al and would greatly appreciate any information on previously mentioned Dr's or any Dr's in the Atl-Birmingham-Nashville areas.

    I'm about to loose my mind and all my hope, so if you could offer any relevant info it would be greatly

    Thanks and Best Wishes to all!
    painpaingoaway ~X(

    Now Here Are The Ugly Details..
    Several epidural injections for DDD, S.I. joint and Facet joints,Radial ablation on facet joints right & left sides,
    laminectomy & disctomy(please excuse spelling!)on 2 ruptured disc. in 2004. Now have new bulge in L5-S1
    anular tear (not told of specific area) Flat back syndrome, an extra lumbar disc, extreme 'loose ligaments' problem???PT, Massage Therapy, TENS,Frequent heating pad use which led to "heating pad back"-discoloration and overall damage to the skin. RX lido-ointment 5%---All with little to no Help. Currently Using ICE whenever I can, TENS as needed, Klonopin 3 1/2 mg for resulting anxiety and tension (and insomnia)Massage therapy when I have the $$$, Prozac 20mg,Flexeril 10mg as needed for spasms,Fentanyl 75's every 2 days, and finally-10mg Hydracodone every 6 hours for 'BT' pain (which is NOT enough!!!) Ugggg.....!

    That's All Folks....
  • The Dr at the spine center I went to told me that it didnt matter how big the tear was. A trear is a tear. The disc fluid is extremly irritationg to the nerve. My discs never healed and so in Dec I had a two level fusion and discectomey, with cadavar bone. I still have alot of pain, but I think it is nerve damage from the two yeats of waiting to find out what was wrong. The only way they found it was by discogram. I still have one torn disc, but it isnt torn all the way through. My Dr wanted to wait until it got bad, because the more levels you fuse, the higher risk you have of a non fusion. So at some time I will probably have to have it fused as well. I dont regret the fusion at all, even with all my pain. I dont have as much pain as before, I walk straigher, and have hopes that it will keep improving. My Dr told me in April that is would lake 6 months to a year. I am only 5 month out now.
  • My MRI's have shown measurements on the larger protrusions or extrusions. But the way the type up the MRI results varies from technician to technician. My previous MRI listed 4 synovial cysts, but the one I just had done didn't mention any.
    Here is a copy of my last MRI results (My biggest problem is at L5/S1.):

    Technique: The following pulse sequences were acquired:
    1. Sagittal T1, T2 STIR
    2. Axial T2, proton density

    Findings: 5 lumbar vertebrae are assumed for purposes of this dictation. There is no marrow infiltrative of destructive process demonstrated. Mild discogenic endplate changes are present at L5/S1. No spondylolysis is detected.

    Conus medularis: The conus terminates at L1. no conus distal cord lesions are seen. The nerve roots in the theacal sac are unremarkable.

    Soft tissue structures: Prominent right renal atrophy cortical scarring are present. The included portions of the left kidney grossly unremarkable. The right kidney is only partially included on this exam.

    Disc spaces:

    S1/S2: A rudimentary disc is present at this level. There is no Stenosis.
    L5/S1: There is a large right disc extrusion which measures 20 x 11 mm in the axial plane and extends 16 mm in craniocaudad extent. This causes moderately severe spinal stenosis with the thecal sac measuring only 4 mm in AP dimension. This causes some mass effect on the transiting right S1 nerve and to lesser extent the transiting left S1 nerve. It does distort the thecal sac as well. Minimal foraminal narrowing. Moderate facet osteoarthritis.

    L4/L5: Mild annular bulging. No canal stenosis. Mild facet osteoarthritis.

    L3/L4: Disc desiccation with mild facet osteoarthritis. No stenosis.

    L2/L3: Mild facet osteoarthritis. No stenosis.

    L1/L2: Mild annular bulging. A small posterior central disc extrusion is present measuring 6 x 2 mm with a small amount of disc material extending cephalad along the posterior margin of the L1 vertebral body. This does not cause significant stenosis. Mild facet osteoarthritis.

    T12/L1: Normal disc.

    T11/T12: Left facet osteoarthritis and ligamentum flavum thickening causing mild left foraminal narrowing. No significant central narrowing. Mild anterior disc bulging.

    1. Findings most significant at L5/S1 where there is a larg disc extrusion completely filling the right lateral recess and causing significant mass effect on the thecal sac. Moderate spinal stenosis.
    2. Small posterior central disc extrusion at L1/L2.
    3. Mild degenerative changes at other levels as above.
    4. Right renal atrophy with significant cortical scarring. This may relate to a remote vascular event, reflux, obstruction, or remote inflammatory process.
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