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What Is an Annular Tear?

POSTED ON IN Back/lumbar Regenexx Spine Procedures Regenexx-PL Disc Regenexx-SD BY Chris Centeno

Many patients don’t know that it’s possible to tear the disc in their neck and back. When this happens it’s called an annular tear. So let’s explore what happens.

The annulus is the tough, fibrous outer covering of our spinal discs. The spinal discs live between each of the bones that make up our spine, and these discs function as shock absorbers for those bones. The inside of the discs is made up of gel, and that gel acts like a scaffold that supports and holds everything up by putting pressure against the annulus.

What is an Annular Tear?

With wear and tear or trauma, the annulus, that tough, fibrous covering, can tear. The brief video above provides a clear image of these structures and what an annular tear looks like. The key thing to understand here, however, is that not all annular tears seen on MRI cause back pain.

Now that we’ve answered the question, what is an annular tear, let’s delve a bit deeper into whether or not an annular tear might be causing your back pain.

Is My Annular Tear Causing My Back Pain?

An annular tear on MRI, as you will see on the video, shows up as a white spot in the back part of the disc. The disc annulus is black on the MRI, so the white spot is easy to see. This spot is also called the high-intensity zone (HIZ). So if we see that white spot on your MRI, is there a way to tell if it’s causing your back pain? One indicator would be the brightness of the spot. If the white spot, the tear, is very bright on MRI, it’s more likely to be causing your pain. If the tear is more of a dull white, it’s less likely to be causing your pain. To help you understand this difference, the video shows side-by-side images of both a bright-white spot and a dull-white spot.

Additionally, the disc is also more likely to be painful if you’re younger, under age 50, than if you’re older.

The only reliable way, however, to find out if an annular tear is causing your back pain is via a discogram. During a discogram, the disc is pressurized with an injection inside the disc. The doctor uses this pressure to see if the disc is painful. This test can give a clear indication of whether or not an annular tear is the cause of your back pain.

Treatment for an Annular Tear

Back fusions are often the route orthopedic surgeons will take to treat disc issues, but this can lead to more problems. A fusion is when the surgeon bolts together the spine bones. However, this leads to overload of the discs above and below and can damage these other areas. To understand this, please see video here.

If your annular tear is causing your pain, an injection of high-dose stem cells (HD-BMC), based on our experience, may be able to address your tear and take care of the pain. Watch the video above to see images of an annular tear before a stem cell injection and after the injection. Additionally, click on the links below to learn more about the treatment of annular tears:

The upshot? The answer to the question, what is an annular tear, is actually twofold. An annular tear seen on MRI doesn’t automatically mean the tear is the cause of your back pain. These tears can just be normal wear and tear and can be found in patients who are experiencing no back pain at all. However, if they are causing the pain, it may be a good idea to look for regenerative medicine solutions to treat your annular tear.





    Dawood says

    Hi,after 70 days my SSP and ISP tendons tearness, I had an open operation on my rotator cuff 47 days ago I am in physical therapy term,but I am not satisfied inhabitation on my arm!What can Ido?!...


    Chris Centeno says

    For us to offer an opinion, you'd need to submit the Candidate form so that you can upload your MRI's and medical history. Once that's done, you will be contacted to set up a time to speak with one of our Physicians about you case. Please see:


    Ricky Everest says

    Has regenexx treatment been shown to heal or seal off inner annular tears?


    Chris Centeno says

    We treat Annular tears regularly. Please see:


    Brijesh Rudani says

    Why r u not posting success rate of stem cell therapy if it's really successful ?


    Chris Centeno says

    Success rate depends on the type of back issue and some patients are not a candidate for stem cells at all.


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    About the Author

    Chris Centeno

    Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…

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