Annular Tears and Fragments – Part 2 What Causes Them?
What Causes Annular Tears of the Lumbar Spine ?
The diagnosis of annular tears is very common, yet they are rarely discussed. What causes the annular tears ? Are annular tears just a result of torsional and compressive forces acting on the discs or is there something else entirely contributing to the annular tear ? Something not readily seen on the MRI or discogram.
I believe the answer is yes, there is something else causing the annular tears-free floating fragments and they can be seen with an endoscope inside of the disc. Unfortunately, you can’t see these fragments on an MRI or discogram, but a disc with an annular tear is full of them. These are relatively soft fragments that seem to randomly float throughout the inside of the disc with nowhere to go.
If these fragments were much larger, it would make sense that they could escape from the inside of the disc and move beyond the annulus to cause a prolapse or an extrusion. However these fragments are soft and small (about the size of half of a grain of rice).
Where do these fragments come from? It is my belief that these fragments are the byproduct of the nucleus which has broken off from its nutritional supply after a trauma, minor or significant. The nucleus begins to fragment after being separated from its nutritional supply.
Everybody seems to confidently understand a disc protrusion or extrusion. They are easy to see and to correlate with the pain from a disc herniation as it pushes on a particular nerve, but what about the situation where the nucleus fragments into small pieces ? Fragments too small to herniate, but large enough to migrate from the center of the disc to the periphery causing an annular tear.
Why aren’t these fragments ever discussed or referenced ? Because the only way to see them is with an endoscope inside of the disc and very few doctors are putting a scope inside of a disc that is causing chronic pain.
However, when you do look inside of a degenerative disc that has been stained with an acidophilic dye, like methylene blue or indigo carmine, you can see a disc space full of free floating, non-viable fragments. The acidophilic dyes will stain the nucleic acids of the dead cells. These fragments are also stuck in the annular fissures and act as a mechanical reason that the fissures cannot heal themselves. The interposition of the fragments in the tears appear to prevent any ability to heal.