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  1. #1
    Join Date
    Sep 2007

    Default Annular Tears At L4-5; L5-S1

    Discogram report revealed annual tears at L4-5; L5-S1. Anyone know what ortho surgeon does in this case? Fusion, replacement, etc.?
    Thanks for any and all info.

  2. #2
    Join Date
    Feb 2007

    Default Re: Annual Tears At L4-5; L5-S1

    Annular tears, have you googled them? AND PUT IT IN QUOTES WHEN YOU GOOGLE, so you get the words in the correct order.


    A large percentage of the population have annular tears. Many folks have them, and are not aware of it, they are asymptomatic.

    Unless they are serious, probably no medical intervention.

    Here is part of an article from Johns Hopkins hospital:

    BACKGROUND AND PURPOSE: Annular tears of lumbar intervertebral disks are found in both symptomatic and asymptomatic persons; therefore, it is difficult to determine whether these findings indicate acute abnormality. Our purpose was to determine whether the MR imaging findings of tears (ie, hyperintensity and contrast enhancement) of the annulus fibrosus persist or resolve over time.

    The natural history of annular tears in the lumbar spine has not been widely studied. Considering that these lesions are relatively prevalent in both symptomatic and asymptomatic persons (2, 8, 9), it is difficult to determine whether their presence on MR images represents an acute abnormality associated with a recent onset of pain. Our purpose was to determine whether the MR imaging findings of an annular tear persist or resolve over time, and if they resolve, whether their presence could imply acuity of the tear.

    Here is something else: - 12k -

    Definitions: Annular Tear
    The annulus is the fibrous ring of the disc structure which surrounds the centrally located soft nucleus of the disc. The nucleus and annulus function together to create a pressurized structure that acts as a shock absorber. The annulus is a ligament and like any ligament in the body can be torn. Tearing of the annulus can produce pain because the annulus has pain fibers within its structure. Many episodes of low back pain are probably tears in the annulus.

    The diagnosis of annular tearing can be made on MRI imaging but the definitive diagnosis is made on CT-discograms where dye is injected into the nucleus of the disc leaks out into the torn area of the annulus.

    Non-Surgery Treatment
    Treatment can consist of time to reduce symptoms, physical therapy, bracing, medications, etc.

    Surgical Treatment
    In very selected situations, the symptoms from the annulus may be treated with intra-discal electrothermal treatment. Occasionally, patients have enough persistent pain from annular tears and internal disc disruption to undergo a fusion of the disc space at the level of the tear.

    The prognosis of annular tears is generally the prognosis of low back pain. Annular tears can be the precursor of the herniated disc.

  3. #3
    Join Date
    Sep 2007

    Default Re: Annual Tears At L4-5; L5-S1

    The discogram report states: at L4-5 level, the contrast is tracked posteriorly from the central nucleus pulposis through the annulus into epidural space and on the right paracentral aspect consistent with annular tear.
    At L5-S1 level, the contrast is tracked posteriorly from the central nucleus pulposis through the annulus into centrally herniated disc consistent with anular tear.

  4. #4
    Join Date
    Sep 2007

    Default Re: Annual Tears At L4-5; L5-S1

    Thanks Princess!!!!

  5. #5
    Join Date
    May 2008

    Default Re: Annual Tears At L4-5; L5-S1

    I have the same exact problem as you, plus severe degenerative disc and moderate degenerative disc. I have had a backache for two years now. I am waiting to have a two level artificial disc replacement once it is approved by the FDA (one levels were approved in 2006 and Aetna pays for them) and my only other best option is a two level fusion, which I am trying to avoid. There are a couple of minimally invasive procedures out there in which they go in and try to seal the tears, however there aren't any guarantees that they will last and most insurance companies don't cover them and they cost thousands of dollars, plus you may have to fly out of state and you would have that expense too. In my case I was given this type of option too namely, selective endoscopic discectomy with thermal annuloplasty, but after the preauthorization for the procedure was denied by my insurance and then denied by the State of Connecticut Insurance Commissioner, I had to give up on that option as the price was around 10,000.00. I am not going to spend that for a medically necessary treatment. That is why I pay for insurance. Anyway, Aetna is the best insurance and I am switching to them as soon as the FDA approves the 2 level. Also, I found that Lyrica has helped me tremendously with my back pain. I take 50mg three times a day. It is expensive however, and does likely cause weight gain, but functionality at this point is more important to me. Now I have 5 good days out of 7 compared to 2 good days out of 7 and I only took Vicodin before. If I aggrevate my back, i.e. bending or lifting, I will pay for it and then even the Lyrica does not help.

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