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Annular Tear: The Great Masquerader. Great article, found my problem

After my L5/S1 fusion in 2012, I have been in more pain than before the fusion, with all Dr.'s saying I shouldn't be in this much pain,etc. During my last appointment with the PA, I had to fight to get her to recommend another mri. She kept saying that I have sacroiliitis, which I have had before. I asked why then did the pain also go down the outside of my thigh, but not below the knee?

So, they approved the mri, and I got the results back. Miraculously, aall of my issues (stenosis, bulges,etc) that were "severe" 1-1/2 years ago, were now "mild to moderate)! But the one big difference is an annular tear in L4/L5 that wasn't there before.

On researching annular tears, I came across a series of articles from Michael N. Brown, MD from Washington state. His article "Annular Tear: The Great Masquerader" pinpoints not only my exact problem, but describes in detail what I felt BEFORE I had my surgery, which, of course, was never corrected, because it wasn't accurately diagnosed. Everyone saw that L5/S1 was totally degenerated and thought that must be the problem. And then, when that was fused. it placed even more stress on the L4/L5 level, causing even more pain!

I recommend everyone who has lumbar problems read his articles. They were an eye-opener for me!
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Comments

  • itsautonomicitsautonomic LouisianaPosts: 2,561
    That is why I am so glad they did a discogram on levels above and below the site they were going to fuse. Found annular tear and treated it with ESI and what had caused severe pain for 7 years is now only mild. I had doctors tell me annular tears should not cause pain, that MRI should show when I asked about if I could have them etc. They were not right in this , i can firmly say 100% in my case my annular tear was causing majority of pain. IMHO annular tears are a huge source of misdiagnosis and often the poeple who hurt but scans look ok often have annular tears. MRI does not always show and discogram often finds. The doctor who found the tears said annular tears make up over 50% of his practice treating pain in regular people and athletes.
    What was your pain before surgury ? My annular tear pain was like a burning knife in back.
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • Yep, burning, knife in back, and if I sat for more than half an hour, I couldn't stand up. I had to inch my way up. The same thing happened 3 weeks ago (in the shower at the gym, no less!) I was posted! To go through a long painful surgery, a long painful recovery, and to still have the same problem?

    It seems that we are more informed than the people who are treating us!
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  • itsautonomicitsautonomic LouisianaPosts: 2,561
    Yea I could not imagine if I would have had thoracic fusion and woke to the same stabbing pain or worse pain and go on to discorver the annular tear then. The problem i saw with annular tears is when I spoke to some doctors about it the response was that old saying that I see them all the time on scans and they dont cause pain. I dont know if conicidence but those were older doctors, the younger ones said yes they often do cause severe pain and explained why. My doctor and I discussed an ESI targeting it after found and even though they didnt put much faith in it, the injections worked like a charm. I suggest you have a discussion with your doctor about the same, could it potentially help?
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • I think it depends on the grade of the tear, and if there is a disc herniation or protrusion along with the tear. Mine didn't show up on the MRI either. They were diagnosed during my discogram.

    Spinal Health Moderator 

    Retrolisthesis C4 of C5 and C5 of C6
    Spondylolthesis C5/C6
    Disc protrusions with Annular Tears C3/C4, C4/C5, and C5/C6
    Disc Material Compressing Spinal Cord C3/C4
    Severe Forminal Stenosis C5/C6
    DDD
    Ankylosing Spondylitis 
    Annular Tears L3/L4 and L5/S1
    Enlarged Facet Joints/Facet Anthrosis L3/L4/L5
    PLIF with Rods, Cage, and Pedicle Screws-L4/L5
  • itsautonomicitsautonomic LouisianaPosts: 2,561
    edited 02/20/2015 - 8:01 AM
    None of mine showed up on any MRI scan, all 3 leaked dye , but T5-6 was the main pain generator, my herniation at T6-7 had tear also but not as painful on discogram.
    Were yours painful on discogram , jillybean079 ?
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
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  • Omg yes. I was crying after the dye was injected in the L4/L5 and L5/S1, both were I have grade 4 tears...

    Spinal Health Moderator 

    Retrolisthesis C4 of C5 and C5 of C6
    Spondylolthesis C5/C6
    Disc protrusions with Annular Tears C3/C4, C4/C5, and C5/C6
    Disc Material Compressing Spinal Cord C3/C4
    Severe Forminal Stenosis C5/C6
    DDD
    Ankylosing Spondylitis 
    Annular Tears L3/L4 and L5/S1
    Enlarged Facet Joints/Facet Anthrosis L3/L4/L5
    PLIF with Rods, Cage, and Pedicle Screws-L4/L5
  • itsautonomicitsautonomic LouisianaPosts: 2,561
    Yea even though I was on versed, I still remeber coming off the table and trying to scream when the pressure hit. I couldnt scream I just hit the table with my fist. I never had a grade assigned to mine, the doctor just said they are pain generators in your case and the dye came leaking out of all of them. hurts to even think about again
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • Jillybean079Jillybean079 Posts: 305
    edited 02/20/2015 - 8:32 AM
    I didn't have any sedation. I wouldn't wish that test on my worst enemy. Mine did the same...the dye came leaking out. At least that part is over for you and me both!!! It would be on the report from the discogram itself, but if the dye was leaking out on yours as well, it is probably a grade 4. I don't think I ever asked you...did you have surgery at all?? They are fusing my L4/L5 next week...I just have so many problems with other levels as well...I'm hoping it helps some with the pain..

    Spinal Health Moderator 

    Retrolisthesis C4 of C5 and C5 of C6
    Spondylolthesis C5/C6
    Disc protrusions with Annular Tears C3/C4, C4/C5, and C5/C6
    Disc Material Compressing Spinal Cord C3/C4
    Severe Forminal Stenosis C5/C6
    DDD
    Ankylosing Spondylitis 
    Annular Tears L3/L4 and L5/S1
    Enlarged Facet Joints/Facet Anthrosis L3/L4/L5
    PLIF with Rods, Cage, and Pedicle Screws-L4/L5
  • itsautonomicitsautonomic LouisianaPosts: 2,561
    yea I looked for the grade on the discogram testing reports, but they never put one there. I really wasnt concerned enough to ask because I knew it hurt whatever grade it was. Yes I am glad its over and I am glad mine was so positive because with sedation I may have had to do it again without sedation if there were some questions about which one.
    No I never had surgury, they canceled my surgury after the tears were revealed as we were going to do 1 level fusion at T6-7 where herniation was, but the thought of 3 levels scared my surgeon so he said we need to step back. We talked and I was against another ESI for herniation and I asked if a ESI could help tear and he said wouldnt hurt to try if I wanted to , I said yes. I knew instatly that ESI did something different than all my others that targeted the herniation, the stabbing, knifing pain that was the hardest part to deal with melted away and has for the most part never came back. The pain I have now is much more manageable in my thoracic spine. It was strange I felt like my spine in that area began to strengthen shortly after ESI and my exercising seemed to work where it hadden prior. The doctor thinks we broke the inflammation chain . That was in 2010 and Ive had one more in same area since when knifing came back. Was a game changer for me.
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • itsautonomicitsautonomic LouisianaPosts: 2,561
    lacarpenter an old member son had fusion at your same level for tear ( been a while but pretty sure same level) and he did extremely well, but that was his only spine issue. His pain level dropped signifigantly, he also had discogram that showed tear and herniation . He had a stem cell injection into the disc with tear that actually damaged disc with to high pressure to the point where he was forced into fusion, but results were good.
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
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