Annular tear: what it means on your MRI

What is an annular tear?

A separation in one or more layers of the annulus fibrosus, the tough outer ring that holds a disc's gel-like center in place.

Each disc has two parts: the soft center (nucleus pulposus) and layered outer rings (annulus fibrosus). A fissure is a gap in those layers. Tears can run in rings, across, or outward from the center (radial). A radial tear that reaches the outer edge is what allows a herniation to happen (StatPearls, NIH/NLM).

The standard radiology nomenclature prefers the word "fissure" because "tear" suggests an injury, while most fissures are part of normal age-related disc change (Fardon et al., 2014). See also how to read your MRI report.

Does an annular tear cause pain?

Often no. Most are found incidentally on imaging. When they do hurt, the pain is usually deep and local to the back.

According to StatPearls, a symptomatic annular fissure can cause two kinds of problems:

• Local disc pain: a deep ache in the low back that's worse with movements that stress the disc. The exam may look fairly normal.
• Nerve symptoms: if the tear irritates a nearby nerve root, or disc material herniates through it, pain, tingling or weakness can travel down the leg (sciatica).

Cleveland Clinic notes that small disc tears are often near nerves and can trigger inflammation, even when minor.

Why does my MRI say "high-intensity zone"?

That's a bright spot on certain MRI images that often marks a fissure in the outer ring.

On T2-weighted MRI images the healthy annulus looks dark. A fissure holds more fluid, so it shows as a bright spot (StatPearls). Radiologists may call this a high-intensity zone, or HIZ. It's a description of what the image shows, not proof that the disc is the source of your pain. MedlinePlus cautions that MRI often finds age-related changes that aren't causing current symptoms.

How is an annular tear treated?

Usually with conservative care: activity changes, anti-inflammatory medication and low-impact physical therapy.

• Stay active within comfort. Avoid long periods of slumped sitting and heavy lifting while it's sore.
• Anti-inflammatory medication and low-impact physical therapy are typical first steps for a painful fissure without herniation (StatPearls).
• Injections or, rarely, procedures are considered when pain persists and the disc is confirmed as the source.

Tears in the outer ring heal slowly, since that tissue has a limited blood supply. The MRI finding may stay the same even when you feel better, which is one reason to treat the person, not the picture.

Can spinal decompression help an annular tear?

It's sometimes considered when a tear comes with a bulge or herniation and lasting disc-related pain. The evidence is limited.

Decompression uses slow, cycled stretching on a motorized table to reduce load on a disc. It's non-surgical and drug-free. There isn't good research specifically on decompression for annular tears, and reviews of traction in general haven't shown a clear benefit (Cochrane). Dr. Gordon Stapel, DC looks at your symptoms, exam and MRI together and will tell you if he doesn't think decompression is reasonable for you. Bring your MRI for a free MRI review, or call (801) 491-8688.

This website is operated for Stapel Family Chiropractic (Springville Disc Center) in Springville, Utah. Care is provided by Dr. Gordon Stapel, DC, a licensed chiropractic physician. About this site.