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Is Annular Tear Surgery Effective?

annular tear surgery

Many people living with debilitating back pain are led to believe that annular tear surgery is an effective way to treat annular tears. Considering the fact that annular tears are so common among adults and they’re the underlying cause of so many conditions, it’s no wonder spine specialists and patients are searching for the best way to treat them. Degenerative disc disease, sciatica, herniated discs, and chronic low back pain are all conditions that often occur as a result of annular tears.

This is why it’s beneficial to understand the best way to treat annular tears and the true cause of annular tear pain. Keep reading to learn what annular tears are, what causes them, whether annular tear surgery works and more.

What Are Annular Tears?

Before explaining annular tear surgery and what an annular tear even is, we have to discuss the anatomy of the spinal disc.

Your spinal discs are made of two parts: the annulus fibrosus and the nucleus pulposus. The annulus fibrosus is the outer portion of the disc, made of 22-25 layers of fibrous collagen rings. These rings encase the nucleus pulposus. The nucleus pulposus is the inner layer of your spinal discs and is a jelly-like substance that will leak if not contained by the annulus fibrosus. 

In addition to containing the nucleus pulposus, the layers of the annulus fibrosus also contain sensory nerves.

The purpose of your spinal discs is to absorb shock between the vertebrae. Whenever you participate in a high-impact activity, your spine sustains trauma, or you exert or strain your back, the spinal discs absorb the impact. Although this is what they’re built to do, this stress wears your discs down over time. Over time, discs can be worn down to the point of developing tears in the annulus fibrosus, known as annular tears. 

Annular tears can occur anywhere throughout your spine, but they usually develop in the neck (cervical spine) and lower back (lumbar spine) because these are the most mobile areas of the spine. Lower back issues are especially common because the lumbar spinal discs take the most stress in day-to-day activities and movements.

annular tear surgery

Types

There are three types of annular tears: transverse, radial, and concentric.

  • Transverse tears reach from the outer rim to the inner layers of the annulus fibrosus. This type of tear leads to the most significant pain.
  • Radial tears don’t cause as much pain as transverse tears. They usually occur in the innermost layer of the annulus fibrosus, but they can grow until they reach the outer rim.
  • Concentric tears occur in the ring around the nucleus pulposus. They commonly result from torsional injuries which are caused by repetitive and excessive twisting of the spine.

 

Causes

Earlier in this article, we briefly mentioned some things that can cause annular tears to develop, so now we’re going to go into further detail.

The most common cause of annular tears is aging. In fact, just about every adult will have developed annular tears by the time they leave their teen years. This is because the spinal discs simply become worn down with age which leads to tearing. It may be helpful to think of the annulus fibrosus like a rubber band. A new rubber band can stretch out and easily snap back to its original size and shape but over time, or with more vigorous stretching, it will develop cracks and tears.

Certain occupations can also cause annular tears if they require heavy lifting, bending forward, or twisting. Even sitting at a desk for long periods of time can cause tears to develop because of the stress that sitting puts on the lumbar spine. High-impact sports and activities also place high stress on spinal discs and can cause tears.

Even genetics can determine your likelihood of developing annular tears. The strength and quality of the collagen that makes up the annulus fibrosis is determined by your genes. If this collagen isn’t particularly strong, your likelihood of annular tears increases.

Symptoms

As mentioned earlier, the annulus fibrosus contains the nucleus pulposus. When annular tears develop, the annulus fibrosus’s ability to contain the nucleus pulposus is affected, leading to leaking. When the nucleus pulposus leaks and comes into contact with the sensory nerves in the annulus fibrosus, it can cause irritation, inflammation, and pain in the disc. The leaking nucleus pulposus may also leak onto surrounding spinal nerve roots, irritating these nerves as well. These irritated nerves may then refer irritation pain to the extremities, causing pain in the arms, hands, legs, and even feet. This is what is known as Leaky Disc Syndrome.

Leaking also causes the spinal discs to break down in general due to dehydration (disc desiccation), which lowers the ability of the spinal discs to continue providing flexibility for the spine.

Here’s a more complete list of symptoms caused by annular tears.

  • Localized or “discogenic” pain, meaning pain in or near the torn spinal disc(s).
  • Pain in the arms, legs, hands, or feet.
  • Muscle weakness.
  • Tingling or numbness in the limbs.
  • Pain that feels worse when you sit, bend forward, lift, or twist.
  • Pain that feels better when you switch positions, lie down, walk, or run.

You can learn more about the signs and symptoms of annular tears here.

Diagnosis

In order to determine if you’re suffering from an annular tear, you’ll discuss your medical history with your doctor and undergo a comprehensive physical exam to evaluate your pain and symptoms. X-ray imaging may also be used to evaluate your spine. However, magnetic resonance imaging (MRI) is most commonly used to identify annular tears. Although MRI can sometimes diagnose annular tears, it should be noted that in many situations tears aren’t visible on MRI. This is why Discseel® Procedure physicians only rely on the Annulogram to successfully identify annular tears.

annular tear surgery

Why Annular Tear Surgery Can’t Heal Back or Neck Pain

Annular tear surgery is usually only recommended after conservative treatment has failed to provide relief. There are a few different ways surgeons attempt to solve annular tears.

  • Using a laser to seal the tear.
  • Spinal fusion, which fuses two or more vertebrae together to stop movement.
  • Discectomy, a procedure that removes portions of a spinal disc to relieve pressure.
  • Disc replacement, which removes the damaged disc entirely and replaces it with an artificial disc of some kind.

However, it’s clear that the true cause of annular tear pain is inflammation and irritation caused by the nucleus pulposus leaking out of the disc. None of these surgical options address this chemical inflammation. Using a laser to seal the disc is on the right track, but lasers don’t actually provide lasting healing for annular tears and this still requires surgery, which comes with risks. 

In addition to this, spinal fusion often worsens the health of your spine by placing increased strain on areas near the fused vertebrae and accelerating the development of annular tears.

But if annular tear surgery isn’t actually able to address and heal tears, what are your options?

How the Discseel® Procedure Heals Annular Tears

The bottom line is that annular tear surgery can’t address or solve the pain caused by annular tears. The only way to actually solve the pain and conditions caused by annular tears is by sealing the torn disc. How can this be done? The only procedure that’s been proven to do this effectively and with lasting success is the Discseel® Procedure. This procedure is non-surgical, minimally invasive, and proven to relieve pain.

How does it work? The Discseel® Procedure takes Fibrin, a natural biologic produced by your body, and applies it to torn spinal discs. This then seals and heals annular tears the same way your body would seal and heal a cut on your hand or anywhere else on your body. It’s important to seal the spinal disc to stop leaking because this is what actually stops the chemical inflammation and relieves pain. Fibrin also encourages your torn spinal discs to grow new tissue for lasting healing, something they can’t accomplish on their own.

If you’re ready to stop living with back or neck pain, apply for the Discseel® Procedure today and find out if you’re a candidate!

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Kevin Pauza, M.D.

SPECIALTY

  • Disc Biologics
  • Interventional Spine

EDUCATION & DEGREES

  • Fellowship: Interventional Spine, University of Pennsylvania
  • Residency: PM&R, University of Pennsylvania
  • Internship: Surgery & Medicine, Columbia University College of Physicians and Surgeons
  • Medical Doctorate: Pennsylvania State University College of Medicine
  • Bachelor of Arts: Biology, Lehigh University
  • Bachelor of Arts: Psychology, Lehigh University

CERTIFICATIONS & LICENSES

  • Texas State Medical and Surgical License
  • New York State Medical and Surgical License
  • Florida State Medical and Surgical License

HONORS

  • Lehigh University Four-year Academic Scholarship
  • Magna Cum Laude, Lehigh University
  • Lehigh University President’s Award
  • Lehigh University Tower Society
  • Distinguished Alumnus, Penn State University (selected from 500,000 Penn State alumni)
  • North American Spine Society, Outstanding Paper of the Year, 2003
  • President-Elect, International Spine Intervention Society
  • Founding Partner, Texas Spine and Joint Hospital
  • Commencement Speaker: Penn State University College of Medicine
  • Advisory Board, AMA
    Keynote Speaker, Harvard Pain Center Commencement
  • Founding Chairman, Standards Committee, International Spine Intervention Society
  • Chairman, Spine Committee, Amercian Academy of Physical Medicine & Rehabilitation
  • Appointed Spine Advisor, Japanese Prime Minister
  • Appointed Spine Advisor, Allied Royal Families

EXPERIENCE

  • Founding Partner & Principal, Texas Spine & Joint Hospital

Travis Foxx, M.D. - Premier Anesthesiology & Pain

Kevin Pauza, M.D. - Turtle Creek Surgery Center

Prior to attending Penn State University, Dr. Pauza earned his undergraduate degree from Lehigh University, and furthered his training with a Surgical and Medical Internship at Columbia University College of Physicians and Surgeons. He continued his specialty training at the University of Pennsylvania, followed by an Interventional Spine Fellowship. In addition to his research, philanthropic, and clinical endeavors, Dr. Pauza remains a motivated educator. He established a Spine Fellowship program and continues training physicians from around the world. He heads international committees responsible for establishing standards and educating surgical and non-surgical physicians.

After helping hundreds of patients who failed to experience relief after spine surgery, it became evident to Dr. Pauza that current methods needed to change. This motivated him to seek better ways to help patients, by thinking outside the box.

Dr. Pauza is the first physician in history to pursue FDA approval for using biologics to treat the spine. Millions of patients will benefit from his development of minimally invasive treatments for degenerative disc disease and other more common and serious disorders of the spine.

SPECIALTY

  • Disc Biologics
  • Interventional Spine

EDUCATION & DEGREES

  • Fellowship: Interventional Spine, University of Pennsylvania
  • Residency: PM&R, University of Pennsylvania
  • Internship: Surgery & Medicine, Columbia University College of Physicians and Surgeons
  • Medical Doctorate: Pennsylvania State University College of Medicine
  • Bachelor of Arts: Biology, Lehigh University
  • Bachelor of Arts: Psychology, Lehigh University

CERTIFICATIONS & LICENSES

  • Texas State Medical and Surgical License
  • New York State Medical and Surgical License
  • Florida State Medical and Surgical License

HONORS

  • Lehigh University Four-year Academic Scholarship
  • Magna Cum Laude, Lehigh University
  • Lehigh University President’s Award
  • Lehigh University Tower Society
  • Distinguished Alumnus, Penn State University (selected from 500,000 Penn State alumni)
  • North American Spine Society, Outstanding Paper of the Year, 2003
  • President-Elect, International Spine Intervention Society
  • Founding Partner, Texas Spine and Joint Hospital
  • Commencement Speaker: Penn State University College of Medicine
  • Advisory Board, AMA
    Keynote Speaker, Harvard Pain Center Commencement
  • Founding Chairman, Standards Committee, International Spine Intervention Society
  • Chairman, Spine Committee, Amercian Academy of Physical Medicine & Rehabilitation
  • Appointed Spine Advisor, Japanese Prime Minister
  • Appointed Spine Advisor, Allied Royal Families

EXPERIENCE

  • Founding Partner & Principal, Texas Spine & Joint Hospital

Brandon Tolman, D.O. - Nashville Spine Institute

Boris Terebuh, M.D. - Regenerative Spine & Joint Center

Boris Terebuh, MD specializes in providing personalized nonsurgical solutions for spine problems that interfere with the function patients desire and the independence they deserve. Dr. Terebuh completed his Physical Medicine & Rehabilitation residency training at The Ohio State University in 1997 and has been in solo practice in Ohio since 2001 because he is committed to providing accessible, individualized and attentive care to his patients. His regenerative approach to solving spine problems enhances the body’s natural ability to heal itself. His guiding principle is integrity – doing what is right for patients in a conscientious manner with the motivation of helping them become fully functional, independent and satisfied. Dr. Terebuh is a very unique Medical Doctor because he has earned seven Board Certifications in the field of musculoskeletal medicine and nonsurgical spine care. Boris Terebuh, MD is delighted to be a Discseel® provider because this revolutionary new technology aligns perfectly with his preferred regenerative treatment approach and patient care philosophy. Dr. Terebuh is also grateful to Discseel® developer, Kevin Pauza, MD, for all the years of diligent and meticulous research to create this innovative, paradigm-shifting intervention, which will certainly spare countless individuals the prospect of avoidable spine surgical procedures.

Thierry Bonnabesse, M.D. - Champlain Spine and Pain Management

Gregory Lutz, M.D. - Regenerative Sportscare Institute

Dr. Gregory Lutz is the Founder and Medical Director of the Regenerative SportsCare Institute (RSI). In addition, he currently serves as Physiatrist-In-Chief Emeritus at Hospital for Special Surgery (HSS) and a Professor of Clinical Rehabilitation Medicine at Weill Medical College of Cornell University. Dr. Lutz is one of the world’s leading experts in the field of regenerative interventional orthopedic medicine, appearing annually on Castle Connolly’s and New York Magazine’s “Top Doctors” lists.

Janet Pearl, M.D. - The Boston Stem Cell Center

Dr. Janet Pearl has been in practice since 1999 and is the Medical Director of The Boston Stem Cell Center. She is also the Medical Director of  Complete Spine and Pain Care  an interventional integrated Pain Management practice, both located in Framingham, Massachusetts. Dr. Pearl is Triple Board Certified in Regenerative Medicine, Pain Medicine and Anesthesiology and has over 20 years experience in doing these procedures.

Previously, Dr. Pearl was the Co-Director of the Pain Management Center at St. Elizabeth’s Medical Center, where she was also the Director of the Pain Management Fellowship program.

After graduating from Harvard College with an A.B. in Applied Mathematics with Economics, Dr. Pearl received a M.Sc. in Health Planning and Financing at the London School of Hygiene and Tropical Medicine. She then received her M.D. from the Columbia College of Physicians and Surgeons, where she represented the Medical School as a senator in the Columbia University Senate.

Watch Dr Pearl give an introduction to The Boston Stem Cell Center

Dr. Pearl completed her internship in Internal Medicine at New England Deaconess Hospital, her residency in Anesthesiology at the Massachusetts General Hospital, and her fellowship in Pain Management at the Brigham and Women’s Hospital. Dr. Pearl was the first resident ever to serve on the Accreditation Council for Graduate Medical Education (ACGME)’s Residency Review Committee for Anesthesiology. She is a Joseph Collins Scholar and a Rotary Scholar and was awarded the AMA/Glaxo Welcome and AMA/Burroughs Welcome Resident Leadership Awards.

From 2004 to 2010, Dr. Pearl served on the University of Massachusetts Board of Trustees. While there she chaired the Committee on Science, Technology and Research, was a member of the Committee on Academic and Student Affairs and the Governance Committee and also served as Vice Chair of the Advancement Committee, and as a member of the Committee on Athletics.

Dr. Pearl is Board Certified in Regenerative Medicine, Pain Medicine and Anesthesiology with the American Board of Regenerative Medicine and the American Board of Anesthesiologists.

Memberships:

  • The American Pain Society;
  • The Massachusetts Medical Society;
  • The Massachusetts Society of Anesthesiologists;
  • The Massachusetts Society of Interventional Pain Physicians;
  • The American Society of Anesthesiologists;
  • The American Society of International Pain Physicians;
  • The American Institute of Ultrasound in Medicine; and,
  • The American Board of Regenerative Medicine.

PUBLIC SERVICE:

  • Member, Massachusetts Department of Industrial Accidents, Health Care Services Board 
  • Member of the Association of Harvard College Class Secretaries and Treasurers
  • Past Member of the Board of Directors of the Harvard Alumni Association
  • Former Member of the Board of Trustees University of Massachusetts. (10/2010 – 10/2014) 

Mark Reecer, M.D. - Fort Wayne Physical Medicine

Dr. Mark Reecer is board certified in Physical Medicine & Rehabilitation and Pain Management. He has over 20 years of work comp experience, and he routinely provides Independent Medical Examinations (IMEs) for the Indiana Workers’ Compensation Board. Dr. Reecer has lectured extensively and has authored multiple publications that promote his specialty and the use of treatment modalities to eliminate pain, improve function and avoid surgery.

Dmitry Buyanov, M.D. - IV Infusion Treatment Center

Dr. Buyanov is originally from Kiev, Ukraine. He received his training in Anesthesiology and his Interventional Pain Management Post-Doctoral at Penn State Medical Center, PA. Dr. Buyanov moved to San Antonio in 2003 at which time he was part of a multi-specialty group before he founded Premier Pain Consultants in 2004. His practice has over 5000 active patients in his practice. Dr. Buyanov treats his patients in a cost-effective manner although giving them the best care with interventional pain treatments/procedure to help each patient improve their quality of life. Dr. Buyanov strongly believes in an individualized and multidisciplinary approach to pain management, he believes in the Buddhist saying: “pain is inevitable but suffering is optional”. He works closely with the area internists, physical therapists, chiropractors, psychiatrists, neurologists, and spine surgeons to insure that each patient has the most optimal individualized treatment plan. Dr. Buyanov enjoys spending his spare time with his children.

Desmond Hussey, M.D. - NASA Neuroscience and Spine Associates. P.L

Dr. Hussey earned his undergraduate degree from Dartmouth College, and proceeded to earn his Medical Degree from The University of Miami School of Medicine. He then attended Northwestern University Internal Medicine Program, followed by a Neurology Residency Program at Emory University. Dr. Hussey continued his specialty training at John Hopkins University pain clinic. A member of The Spinal Injection Society and The American Academy of Neurology and Psychiatry.

Haley Burke, M.D. - Mile High Sports and Rehab

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Maxim Moradian, M.D. - Interventional Spine Care & Orthopedic Regenerative Experts

Dr. Moradian is triple-board certified in Physical Medicine and Rehabilitation (PM&R), Sports Medicine and Pain Management. Dr. Moradian’s clinical practice is devoted to the comprehensive care of spine, joint, muscle, tendon, ligament, and peripheral nerve disorders. He is proficient in performing advanced, minimally-invasive procedures under fluoroscopic and/or ultrasound guidance in the entire spine. Dr. Moradian performs electrodiagnostic testing (EMG/NCS) for the accurate diagnosis of muscle and/or nerve disorders. He has a special interest in regenerative medicine, sports concussions, neuromuscular ultrasound, medical education, and clinical research. His true passion is to treat his patients like his family and friends.

Wendi Lundquist, D.O. - Active Life Physical Medicine & Pain Center

Dr. Lundquist is the Medical Director and founder of Active Life Physical Medicine & Pain Center, Innovative Surgery Center, and Regena Spa. She is dual board certified in Physical Medicine and Rehabilitation along with Pain Management and a diplomat with the American Board of Pain Medicine. She completed her training at Loyola University in Chicago, Illinois in July of 2005. During her time there, she served as Chief Resident and was involved in several research projects. Prior to, she completed medical school at Midwestern University at the Arizona College of Osteopathic Medicine campus in Glendale, Arizona and internship at Doctors Hospital in Massillon, Ohio. She also has a Bachelor of Science in Biology and minor in Chemistry from the University of New Mexico in Albuquerque. She has a special interest in sports medicine, pain and spine. With 17 years experience, she has great enthusiasm towards regenerative medicine.

Yasuyuki Nonaka, M.D. - ILC International Lumbago Clinic

Haley Burke, M.D. - Colorado Rehabilitation & Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Haley Burke, M.D. - Colorado Rehabilitation & Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Matthias H. Wiederholz, M.D. - Performance Pain and Sports Medicine

Founding Partner, Triple Board Certified – Physical Medicine & Rehabilitation; Sports Medicine; Anti-Aging, Regenerative & Functional Medicine

Dr. Matthias H. Wiederholz is cofounder of Performance Spine & Sports Medicine, LLC. He is a fellowship-trained interventional pain physician whose clinical interests include: Interventional Pain Management, Sports Medicine, Musculoskeletal Medicine, Minimally-Invasive Spine Surgery, Non-Surgical Orthopedics, and Anti-Aging / Functional Medicine.

He received his specialty training in Physical Medicine and Rehabilitation at Baylor College of Medicine in Houston, Texas where he served as chief resident. He completed fellowship training in Interventional Pain Management in Marietta, Georgia. He is board-certified in Physical Medicine & Rehabilitation and Sports Medicine. He also received advanced fellowship training through the American Academy of Anti-Aging Medicine and is board-certified in Anti-Aging, Regenerative & Functional Medicine.

Dr. Wiederholz performs a myriad of interventional pain procedures including, but not limited to the following: epidural steroid injections, facet joint injections, radiofrequency ablation, sacroiliac joint injections, discography, percutaneous disc decompression, epidural lysis of adhesions spinal cord stimulator implants, and minimally-invasive discectomies. Endoscopic spine surgery is a very unique and valuable tool in his armamentarium and makes Dr. Wiederholz one of the most specialized physicians in the field of Pain Medicine.

Dr. Wiederholz uses musculoskeletal ultrasound in the diagnosis of musculoskeletal injuries. He incorporates ultrasound for precise injection therapy including cortisone injections, prolotherapy, and PRP (platelet rich plasma). This technology is also utilized to perform the Tenex procedure, a percutaneous procedure for treating chronic tendon pain (tennis elbow, rotator cuff, plantar fasciitis, etc).

Dr. Wiederholz is the fellowship director for the sports and spine fellowship at Performance Spine & Sports Medicine. Dr. Wiederholz holds an affiliation with Capital Health System and JFK Johnson Rehabilitation Institute.

Being advanced fellowship trained in Anti-Aging, Regenerative & Functional Medicine means that Dr. Wiederholz has the most advanced training in Anti-Aging Medicine available. He is a leading expert in Bio-Identical Hormone Restoration and helps patients achieve wellness through nutrition, lifestyle, and hormone therapies.

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Michael Wolff, M.D. - Southwest Spine & Sports