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Tears vs. Herniation

jsirabellajjsirabella Posts: 311
edited 06/11/2012 - 8:43 AM in Lower Back Pain
I just wanted to get it straight and would like to know what these terms really mean. My doctor seems to use them both but they seem to have to different meanings, or do they?

1) Is there a difference between a tear and a herniation? These seems to be a difference? Is that true and what is it?

2) What is the difference of the symptoms? It seems that herniation is mostly related to sciatica pain while tears seem to be closely related to inflammation more in the lower back (for me). Is that true?

I ask this as my sciatica has really been put at bay with the epidurals but it seems I am left mostly now with inflammation which the doctor seems to believe is mostly coming from tears that now have pain fibers(??) in them. That is something I really do not understand and would like to better understand it.

I still have the herniation but according to him the size is too small to be generating this much discomfort so it is believed it must be the tears and trying to understand is there a difference?

3) Will a discography be able to tell the difference of which is generating the pain?

Thank you all for reading...



  • This terminology gets confusing because doctors tend to use both "annular tear" and "herniation" interchangeably sometimes, even though they are not necessarily the same.

    1) An annular tear is simply a tear in the wall of the disc. The disc has pain fibers in it, so the tear and disruption in the disc wall itself can be painful.

    2) A herniation is when the nucleus puloposus of the disc has actually pushed through and is making the wall of the disc bulge. To get this bulge the wall is usually torn/stretched, so if you have a herniation you could also say you have a tear.

    So, you can have a tear without a herniation, but if you have a herniation you also probably have a tear. The herniation is what tends to produce radicular symptoms (including sciatica) because it is the actual bulge of the disc compressing the nerves. People that simply have tears with no herniation would not have radicular symptoms since there would be no neurological compression.

    I think your confusion is that with the herniation you can't really separate out the "tear" element from the "herniated" element. Your sciatica is definitely from the herniation, but the lower back pain could be from the tear in the disc (ie, the wall of the disc hurts because it has pain fibers in it and is torn/stretched)) or from the herniation where it has caused nerve root irritation. Or the low back pain could be unrelated to the herniated disc and could be from a different structure (unlikely, but always possible).

    Epidurals are *highly* specific for nerve root pain, but less so for discogenic pain. The epidural floods the nerve roots with the cortisone since they literally put the steroid right next to the nerve, but with the disc the steroid has to diffuse from the epidural space into the disc. This makes it much less specific for the disc since there is no way to predict or direct the steroid to go where it needs to in the disc. Since your sciatica has gotten better with the ESIs, but the lower back pain has not I think it is likely that the pain is from inflammation in the disc itself (as your doctor suggested), since the steroid definitely hit the nerve root but may or may not have hit the disc very well.

    I think a discogram is probably a logical next step. The discogram will give a detailed image of the disc wall and show any tears where the nerve fibers could be painful. I think with the herniation it is reasonable to conclude that there is some disruption to the annulus where there are pain fibers, so the question becomes "what will this change?" Will he want to treat the disc surgically? Or is he thinking the discogram will rule out the other discs to be positive that the herniated disc is the cause of your low back pain? Discography should definitively find painful discs, as well as give a detailed image of what exactly the disc wall looks like so it should be able to tell you what is generating the pain (as long as it is discogenic pain). It sounds like since the ESI's have not helped the low back pain they just need some more info about what is causing the low back pain. Since the herniation makes the index of suspicion high for discogenic low back pain, the discogram is the test to give more details about the discs. And of course, I'm not a doctor so definitely discuss and clarify all of this with your doctor :)
  • You explain it alot better than my doctor ever did!!

    Yes it does seem like the logical next step to have the discography as the ESI helped but never was able to really get rid of the inflammation just the sciatica. And now the pain I feel running down my legs on bad days when it does reach that point no longer has the same feeling as scitica did but more like straight out inflammation.

    The only other possibility IMHO is an issue with my hips.

    I am starting to look forward to the discography as to either rule out the lumbar or pin it down to the L4-L5. I will sign up for the collagen injection tests he really wanted me to do. Maybe if that works than I will not have to go to the next step which is IDET. I figure if the collagen works than it may help others in the future.

    My understanding is that the discs are joints in a way no different than your ankle or knee and they have found that to help. I will do the 8 week wait to see if it works and if no improvement he says go straight to IDET. He explained we have to do the discography anyway so he will shoot in the collagen at the same time.

    Is the discs of the spine similar to ankles or knees?


    As always Lala thank you...
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  • I'm not sure what your thinking is in comparing a disc to a joint. Facet joints are synnovial joints, just like the other joints in the body. Discs are not intended to have motion. The are designed to provide cushioning between the vertebrae, which does allow the spine to have movement...but the discs themselves do not have movement. Perhaps this is a distinction without a difference.

    What is this collagen treatment your doctor is planning? I've not heard of this. Sounds interesting.

  • At HSS the doctor I am seeing is involved in a blind study where during your discography they will shoot in collagen (blood) taken from your ankle to heal the damaged disc instead of dye. You will still do all the same things as a discography in terms of CT scan and such afterwards.

    He asked me to be involved with the test because my disc really fits the criteria. My understanding is that the criteria is for people who have small herniation, experiencing more than expected pain after 6 mos or longer of conservative treatment with no improvement and still has good disc height or no other obvious issues with their spine. I guess meaning all in one place.

    He explained that since you will need the discography for the IDET you have nothing to loose and all to gain since the collagen is taken from your ankle so no risk involved. They have already done 10 people and 3 have reported 50% improvement after 8 week. He said if I report back an improvement after 8 weeks that they will do another shot of collagen otherwise IDET. He explained the next collagen shot will be nothing like the discography shot if I have it. All costs of the study are covered by the hospital.

    He says the study is trying to see if shooting collagen(blood) into the disc will have the same effect as when they shoot collagen into ankles which they have already proven fixes ankles. He says the main issues most herniations/tears do not heal is due to the lack of collagen/blood in that area.

    My thought was my only loss was 8 weeks of time. I have made the decision that this is the doctor I trust and based upon the way he was asking it almost seemed like he was begging me to do it. I guess most of the people he sees are not good candidates. In addition I really feel if by chance it works I can really help others in the future. We always talk about here how science will eventually come up with new ways to deal with our issues. Without these studies there can be no improvement.

    I hope I am explaining it right...

    In the end atleast it gives me one more shot to beat this issue cause if the IDET did not work I was not going to have surgery unless I could not walk anymore. The doctor told me given the condition of my disc that the prognosis of surgery/fusion was poor and could end up with more pain. He explained it all had to do with the position of the herniation.


    On a side note, really think you and lala should become doctors if the possibility is there. It would be wonderful to have doctors that truly understand what we are going through.
  • I hope this treatment helps your pain. I've never heard of this treatment but hope you will benefit like the other people have. My best. 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
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  • I do not hold out alot of hope on this working. It is a blind study and with my luck when I get the letter I may not even been injected with the collagen but instead the dye. I asked the doctor about this issue and he seemed to hint that I will get it.

    Honestly I am doing it in many ways in the hope that I had some really small part in helping people in the future. I hope by the time my daughter is my age that herniations and tears will be easy to deal with and not be the cause any longer for chronic pain.

    But as I said it gives me one more out before my last out being the IDET. Otherwise it will than come down to waiting 2 and 1/2 more years and hoping that it heals itself. After that...

  • dilaurodilauro ConnecticutPosts: 13,527
    for starters, take a look at our faq. there is a section under medical that goes into some simple information:

    disc definitions

    but i would also search the spine-health libraries regarding various definitions (more formal) about disc conditions
    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences 
  • Hi js.

    I just wanted to throw in something here considering a couple of things you said.
    I still have the herniation but according to him the size is too small to be generating this much discomfort so it is believed it must be the tears. ... And now the pain I feel running down my legs on bad days when it does reach that point no longer has the same feeling as scitica did but more like straight out inflammation.

    The only other possibility IMHO is an issue with my hips.
    Of course, I'd go ahead with what your doctor is suggesting but just wanted to see if your facet joints have also been checked as well as possible stenosis.

    When you said that the herniation isn't large enough to be causing this much pain and now the sciatica is gone, but you have a different kind of pain running down the back of your legs and your hips hurt.

    That's exactly what happened to me. I had a disc bulge at L4/5, so I had an ESI and my sciatic pain (from butt all the way down to feet) was gone. But not too long after, I had what I called a fatter and flatter pain that ran from my butt down the back of my legs to my knees in both legs and had pain in my lower back and radiating into both hips. Really bad pain, especially in my lower back and hips.

    Turned out it was facet hypertrophy (swelling) and stenosis. So because of what you described above, I wanted to ask if you've had anything said about facet problems or stenosis in your lumbar spine.

    Just thinking about this...
  • I have been told so many times that it has to be my L4/L5 from various sources that I kind of been brain washed into believing it. But at the same time the doctors who have told me it is the L4/L5 also say that it should not generate this much pain. They all feel the epidurals should be more than enough to do the job.

    The funny thing is that my pain really sky rockets if I do anything hip dependent. Is there any simple test I could do that could prove it is facet joint issues?

    When this thing all started I did eventually reach the sciatica stage but it was the hips, buttocks that were killing me. You see sciatica for me was always much more of a constant pain that would be more like a constant vibration running through your legs and it had a a constant pacing to it also where it would at times feel like a pulsing electric feel. I had a little of that this morning and some ice and one sodium diclofenic and some standing and it is gone.

    The funny thing is that the real constant through all of this is that along my right and left side of my back is a constant tightness. It really feels like the pain runs from my shoulder blades straight down the extreme left and right outer sides into my hips and sometimes down the leg. It feels like I need to stretch it out so badly and it will go away. But when I do it does nothing or makes it a little worse the next day.

    I do sometimes the exercise many recommended of lying on floor and putting legs on chair. It feels quite good at times for my legs but increases the pain in back and hips when doing too often. Also any type of hip stretch like stretching your right arm up to the left side of your body while pushing your hip out is not a good idea for the next day. My chiro once had me push my hips into the wall to adjust them...god that pain the next day.

    Will the discogram show anything? I guess it will atleast show if the disc is doing it. The funny thing is that I know the discogram will generate pain at the L4/L5 but I am not sure if it will match the pain. I remember during one of my epidurals the first lady got too close and set it off just like the accident but that is not the pain I feel everyday.

    The doctor says cause I have a herniation left/center and tearing on what he thinks will be the right side of the disc that is why I get these different varied pains.

    I am rambling here but Cath111 if any of this sounds familiar please let me know as a discogram is not something I want to do but feel it is needed even to rule out stuff.


  • i agree that you need to have tests done to rule things out like the disc, especially. i'm not sure how my surgeon was positive about my facet problems and stenosis, but it must've come from the mri, xray and/or my symptoms. or maybe partly the tests he did in his office. i don't know of anything you can do to see if you have stenosis or facet problems, i only know what symptoms i had due to them.

    the moist cartilage on my facet joints were gone and there was bone on bone friction causing the lower back pain. as for the stenosis, the opening where the nerves go through were arthritic and had growth that narrowed that space. that was causing the pain in my hips and down my legs. the surgery i had was to fuse the facet joints together and open up space for the nerves to pass freely. they also put in two rods and four screws to stabilize my spine.

    what you say is interesting in that they're sure it's from l4/5 but the disc shouldn't be causing that much pain. i was in the same boat because my disc wasn't too bad, just bulging, so my surgeon went straight to working on the facet joints with injections. i also had a diagnostic nerve block at that level to see if they could control the stenosis with a rhizotomy, but it didn't work. after they got in there during surgery, it turned out the stenosis and facet problems were worse than they thought and found my spine was unstable from spondylolisthesis. i was never told about the spondy before and it came as quite a surprise to me. after the surgery, my surgeon said he was glad i had the surgery when i did since things were worse than originally thought and my spine was so unstable. that's just my personal story of what happened with me.

    what i've been told by my surgeon is that with facet problems, if you lean forward you tend to get relief, if you lean backwards the pain tends to be worse. leaning back presses the facet joints together which is very painful if they're swollen and problematic. standing and walking is more difficult than sitting with facet problems also. i got to the point before surgery that my hubby had to put a stool in the kitchen when i cooked so that if i had to cut up vegetables, do any mixing or stand for any length of time, i could kind of sit on the stool which helped.

    i'm not saying that you have facet problems and/or stenosis at the level of your pain (l4/5) but i think it would be beneficial to have it ruled out. has nothing ever been said to you about the possibility of this? if they already know there's no problems with either of these, then it's a moot point but if not, it might be something to ask about.

    here's an article about the facet joints:

    by the way, i know absolutely nothing about anular tears in the disc so i don't know if that problem can cause the same kind of pain that i experienced and the pain you're experiencing.

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