Question: What are my treatment options for an annular tear?

I have a grade 4 annular tear at my L-4, L-5 and I have had over two years of severe pain. My orthopedic surgeon recommends that I have anterior lumbar interbody fusion surgery (ALIF). I have tried just about everything besides surgery - lots of physical therapy, pain mediation, and two epidural steroid injections. I have two questions: What other nonsurgical treatments could I try and would they be effective? And two, if I should have surgery, are there any options better than an ALIF?

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Doctor's Response: ALIF Surgery may not be the best option

There is not a lot of consensus in the spine surgery world about proper indications for anterior lumbar fusions. Although surgery for a degenerative disc can be useful, for an annular tear alone it is less successful. Those patients that have a lot of disc space collapse tend to do better than those that still have a tall disc and have and an annular tear. Personally, my experience has been that patients also do much better with an anterior/posterior fusion at the L4-L5 level as there is a lot of flexion/extension motion at this disc segment. ALIF surgeries have worked better in my experience for collapsed discs at the L5-S1 level.

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In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues. These responses represent the opinion of one physician, and do not necessarily reflect the views of the broader medical community. The advice presented has not been peer reviewed by Spine-health’s medical advisory board.