- Discussion:
- lesion labeled annuular tear or internal disruption is based on
concept of leaking disc, one which permits the irritating liquid
material normally restricted to the center of the disc to come into
contact with the innervated tissue;
- annular tissue that permits egress of this liquid has a poor capacity
for healing;
- at most, a thin layer of scar tissue at the periphery of the tear may
seal the leak but leave the disc highly susceptible to retearing;
- where as herniated disc has a significant capacity to be resolved w/
time, annular tear continues to produce symptoms indefinitely;
- clinical picture is based on pain related to increased intradiscal
pressure and irritability of neural structures;
- annular tear is usually produced by injury that increases intradiscal
pressure significantly;
- predominant element in the history is back pain, either alone or in
exess of leg pain;
- leg pain may be either unilateral or bilateral;
- increases in intradiscal pressure exacerbate the pain;
- pain is often worse when sitting than when standing;
- coughing & sneezing worsen the pain as do forward bending and lifting;
- on PE no nerve compression is evident;
- key finding is positive sciatic stretch test that produces back pain
or back pain greater than leg pain;
- positive test is presummably produced by tension on irritated dural
tissue or possibly by increased intradiscal pressure;
- myelogram, MRI, & CT, tests show no compression of neural structures;
- key test is discography with CT discography;
- positive examination will show dye extending into the epidural space
or extending to the periphery of the disc where it can contact
innervated portion of the annulus fibrosus;
- posiitve test also requires a reproduction of pain accompanying
injection of dye;
- back pain alone or back pain greater than leg pain;
- increased back pain with increased intradiscal pressure;
- reproduction of back pain to greater degree than leg pain by sciatic
stretch test;
- no neurologic deficit;
- reproduction of pain by discography and discographic dye extending to
or beyond the periphery of the annulus fibrosis;
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Healing potential of the anulus fibrosus.
1990 Volvo Award in experimental studies. Anulus tears and intervertebral
disc degeneration. An experimental study using an animal model.
