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annular tear treatment

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:29 AM in Back Surgery and Neck Surgery
I have been out of touch lately but living with pain right now that is becoming unbearable.Sitting is the worst and then I start thinking and that makes it worse. I am wondering what the most frequent therapy for grade 4 annular tear at l-4 l-5 is. I saw the NS last wed. and he said after 2 years of unrelenting pain, an ALIF is next. I don't seem to be healing on my own and I have weaaned myself off oxyc -80 . Now I know how bad I really hurt with only breakthrough meds to take. Just wondering about treatment others have done after all the conservative kind has been used. I really hurt and need some encouragement to make through another 3 weeks til surgery. thanks so much


  • I had an annular tear at the L4-L5 disc, along w/ a 5mm herniated disc. About four years ago, I opted for the charite artificial disc replacement. This was a great choice. I am pain-free in that disc. Although, I just recently had a rhizotomy for the adjacent facet joints. I have a Transitional Segment, which might be the cause for the facet pains. If you consider having the Charite ADR, I recently learned that CIGNA is covering that procedure. Not all insurance companies cover it - some only cover a fusion, which can have a domino effect of problems on the discs above & below the fusion. The Charite allows for free movement, without compromising the other discs. Good luck!
  • Just curious if you knew. Hopefully I don't have to go down that road though. Sounds like a better alternative over fusion to me.
  • all three discs torn through the annulus left to right and all the center material herniated out. I think your doc is right that something more aggressive needs to be done. Since it's only one level, I'd check into the disc replacement. I don't know how badly a one level fusion would impair your movement, but I can tell you that three levels really sucks. Well, it's getting better, but I'd love to be a little more free and easy in my movements.

    All the best,
    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • Leslie, you are so right! Sitting is THE WORST! I have annular tears and leaks at L4-L5 and L5-S1 and OMG it hurts to sit so bad it makes me cry. I stand a lot and that hurts too, like at parties or friends' houses, because I know when I go to sit how bad it is gonna hurt.

    If anyone can help Leslie and I understand why it hurts so bad to sit, I sure would be grateful!! My discs don't seem to be bulging very much, but I have bad tears and a TON of pain right in the discs. Never had any sciatia down one leg or the other. Just pain in the very middle, when I sit...........owwwww! Leslie, I feel your pain!!! I hope you come back to the forum and post more. I feel like I am the only one on here who experienced this until I just found your post by dong a search for 'annular tears.' Hope you are feeling okay! ~Molly
  • It hurts to sit b/c (and thanks Gwennie for the article), sitting adds close to 30% additional load to the lower spine. What does this mean?
    Gravity is compressing the spine which makes the opening where the nerve comes out even smaller, which means that any compression to the nerve is increased while sitting.

    I have an annular tear at L5-S1. Lost 2 large masses. I am 7 weeks out of revision microdiscectomy. This procedure removed the 'free' disc from the nerve. Of course it means I have very little disc left between these 2 levels so when I sit I'm probably very close to bone on bone which means the opening for the sciatic nerve is very small and compresses it more.

    Hope this helps.
    As for options - > there are a couple of insurance companies that cover 1-level ADR in the USA. You'd be best to check with your actual provider b/c while Aetna may cover it, your plan may not or your combination of conditions may not.

    I would seek a 2nd opinion. There are varying approaches to fusions
    ALIF (front)
    TLIF*/PLIF (back)
    XLIF* (side...but may not be covered by your insurance)

    *these can be "open" or minimally invasive. It comes down to different reasons for picking which side they go in from.
  • Very good treatment option for annular tear is SED - Selective Endoscopic Discectomy invented by Dr. Anthony Yeung (it includes evocative discography).
  • Thanks you, DNice, for that advice and info. So losing weight would really help me out. Especially when you are talking about gravity! But it also hurts to lay down, and I even wake up hurting, while still in bed, after lying there all night. So it's like I can't win, sit, stand, lay, roll over, play dead, everything hurts, LOL!

    I have Medicare and Medicaid. So far, it has always paid for everything I've ever had done, so I don't think my insurance will be a problem.

    The problem is finding a good surgeon, but here in North FL, we have the Univ of FL, "Shands" a teaching hospital---and they say those have the best doctors since they are teaching, I just don't wanna be anyone's first patient, know what I mean!!!
  • With tears you get leaking fluid. The disc fluid is something nerves are aggravated by. So you get a double whammy. The herniation causes disc pressure into the nerves. The leak causes fluid on them that gets them upset. Then they react to let you know about it.

    As far as solutions. There is a basic pattern. If your neuro is saying fusion then he must be convinced that other options are not going to work for you. Just get a 2nd opinion.

  • Z06 its important to know what nerves are involved here:
    1. When you have a herniation which causes pain and radiculopathy, its caused by nerve root compression.

    2. When you have annular tear, nerve root is not in any relation here. Annular tear causes inflammation of nerve endings INSIDE your disc, or to be more precise, nerve endings in annulus fibrosus (sinu-vertebral nerves).

    I think it is always better to try some less invasive approaches and postpone fusion.
  • Keano16 said:

    1. When you have a herniation which causes pain and radiculopathy, its caused by nerve root compression.

    2. When you have annular tear, nerve root is not in any relation here. Annular tear causes inflammation of nerve endings INSIDE your disc, or to be more precise, nerve endings in annulus fibrosus (sinu-vertebral nerves).

    OH Keano, thank you for explaining this, it makes more sense to me now. Inflammation of nerve endings inside the disc. I'm going to look further into that, thank you! oh, btw, Keano, since the nerve root is not in relation here, is this why the Lumbar Epidural Steroid Injection did not work for me? We tried that before we did the discogram. It only made me worse, the epi.
  • Yes. This that could work for you for at least 6 months is L1 and/or L2 ganglion infiltration/RF. Ask your surgeon to do this.
  • Forgot to say, nerve root can be included in problems with grade 5 annular tear, but nerve root significance in this issues is minor.

  • Keano, you lost me at L1 and/or L2 ganglion infiltration/RF....

    I don't know what grade my tears are---how do I find this out? My dr. is Chinese, and he's so hard to talk to sometimes, but he's the only neurosurgeon we have here and he runs the only pain management clinic we have also.

    Anyhow, what were you saying would help---the lumbar epidural? Cause we tried that, and it only made me sorse.
  • Hi, you can see that during discography controlled by CT.

    Lumbar epidural will not help.

    Things that can help you temporary:
    1. L1 and L2 ganglion infiltratiuon (this is not ESI).
    2. Sinu-vertebral nerve rhizotomy

    Surgical methods that may help you, but don't have to help you, depends on doctor technique and your luck:
    1. IDET
    2. Biacuplasty
    3. PLDD

    Treatment that has very good results with annular tears is selective endoscopic discectomy . It is minimally-invasive also.
  • The tests keano talks about are up for debate though. Ins. might not cover either. The IDET has caused some bad problems after. The SED seems good but the doctor will not put it up for a double blind test that would help validate its results so until that is done the jury is out. I am sure many had good results and SED does seem better than IDET, but do your reasearch.
    Herniated T6-7, multiple herniations in cervical, tears in T5-T8. Stenois at levels and smorls nodes from thoracic thru lumbar
  • I listed IDET only as treatment option, because it really is. But to be honest, I don't like IDET because it can do harm, and it is a blind fluroscopically guided procedure.

    SED is good, but as you say blind test is needed. Good thing is that it is MISS, and it does not exclude fusion and ADR.
  • My God, it's like you guys are talking a foreign language here!

    My doctor is well known, well document, Harvard education, has written numberous articles for various journals and has tons of degrees, etc., and he's the only (the best???) Neurologist we've got here in northern FL. I would think he knows what he is talking about. You know-- you have to put your trust into them, right? So you expect them to know what you need, what is best for you.

    My dr. has not even mentioned some of these things yuo guys are talking about. And some of you guys' signatures, wtih all the listings and dates of what you've had done, gosh, it makes me feel like I'm in the wrong place!! Like I don't belong here!

    I am reading all I can, hoping to find someone else like me, and so far I HAVE found a couple of really great connections on here, but Keano, even though I got you at first, near the top of this thread, you guys really lost me there near the bottom, sorry!!

    All 3 surgeons say I need a multi level lumbar spinal fusion, but to try to wait as long as I can beause I am only 41, and having this double fusion now is likely, very likely they said, to cause me to need more fusions later on.

    SIGH....what to do? But you guys sound so much worse than ne! Are you on walkers? Using canes? using wheelchairs or motorized chairs? I walk like a 90 year old woman, not gracefully or sexy like a 41 year old woman should. It's humiliating to me. H=
  • I am almost 50 and had a 2 level fusion in Dec 2008. It was the only option that I had and that was the opinion of 2 Othos. One of which is very well known in the Ortho world. In fact, he wanted me to do all three that had issues. I choose to do two as the more you do the more risks you have of non fusion.
    I am not saying it is the best option for all, and I still have pain, but I think it is from the disc that was not fixed the first time.
    Have trust in your Dr. If you have done your homework, and are confident in him, and have more than one Dr telling you the same thing, I think you need to decide if they are doing what you want or seek out another opinion.
    I had the tears for 2 1/2 years before fusion, and it only got worse not better. That is what happened to me. Hope this helps and Good Luck to you. Take care, Robin
  • Molly,
    while it's good to do due dilligence and learn stuff,
    don't let internet messages overwhelm you. No one on here is a spine surgeon or has examined you and can't really give you instructions.

    You're fine here, no need to feel otherwise. Stick around!
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • I got my new mri report yesterday one of the things it say is annular tear and it may be related to prior surgery –ok what is the common fix (hopefully not the f word)
    I have been having back and leg an foot pain but not like before micro d I don’t get to see my new nero-surgen for 19 days :S
  • Paul is right. We are not surgeons here. You need to trust your doctor. Hopefully you chosen the right one.

    John, annular tear don't necessary need to be pain source.
  • that wood be good i think
    the new mri dose not say disc protrusion but say slight neuro foramen compromise l5 s1
    dose not say from what .?reherniation
    most of the wording is about the tear so i was thinking leakage on nerve roots or ? i dont like what i have been reading about tears
    and paul and you are right we are not surgeons
    but even with them it dose not hurt to hear more opinions and stories
  • I'm with ya, I'm not following along with what those guys are talking about either and I'd like to think that I am up on alot of spine treatment options. I know what IDET and SED are, but with an annular tear, I'm not so sure those treatments would change your physiology enough to fix it/them. What about an ADR/fusion hybrid in order to maintain some flexibility to hopefully avoid adjacent disc disease? Sorry you are in pain.

    Your mind is young and your body will get fixed. Hang in there. :)

  • From what I understand from my research, an annular tear may become innervated (nerve tissue grows into the damaged space; probably to stop us from using our injured backs) and cause discogenic pain. So yes, the disc can be causing pain IMO.


  • Annulus becomes damaged, nuclear material from nucleus comes trough this damaged part of annulus and innervates nerve endings.
  • Fusion if it dose not heal within a year sounds kind of like overkill(take out the spine and it wont hurt any more) so what I understand is that a tear if bad enough lets the fluid out of the disc grade 4-5 ? if the jelly or actual disc material comes out or protrudes it is called herniation? am I on the right track hear ?my terms the tear is like the tire has a small leek and is going flat herniation is like a blow out
  • Standard treatment so far always was fusion (sometimes ADR). I trust that SED will become standard first line of treatment for annular tears.

    You are on right track. Look at chirogeek website for more information (you have images for tear and herniation so you can compare).
  • Note to self: Look up what ADR and SED stand for, LOL.
  • i have resent mri say annular tear l5-s1 i can barely
    sit longer than 15 min makes my leg an foot hurt like h### walking makes leg feel way better but makes back hurt worse its made me nuttyer don"t see surgeon for 4 more days i can almost guess what he is going to say.

    i wish insurance would cover adr
    my L4 disc is all ready looking denigrated and small bulge
  • Or should I say, I assume that's the term...the Ortho Surg just said "the discogram was positive for tears in 3 discs", so am I correct to assume that's what an annular tear is?

    I'm still confused why he's thinking of only fusing L4/5 when there are tears at L3/4, L4/5 & L5/S1...anyone understand this? He did refer me to Neuro Surg to discuss because of the severity of my leg pain & the numbness/weakness in the entire left leg (positive for S1 nerve damage per EMG/NCV, tho showed as "old damage"...however they can tell that I have no clue, lol).

    Dont feel bad BBB...I have a medical degree (Paramedic)& plan to resume nursing school in the fall and I didn't even know a lot of these terms! If someone with a background in the medical field doesn't know, we surely can't fault you for not knowing! But that's one of the reasons we're all here is to learn from each other, so hang in there-you'll get it ;-)

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