To understand annular tears, it is important to understand the following:
The disc is made of rings of tough tissue on the outside called "annulus fibrosus." These rings hold the second region, called the inner nucleus pulposus gel. The annulus fibrosus, is a fibrous substance where all the disc's nerve endings reside. If we're injured, or just grow older, the annulus fibrosus tears. These tears lead to all disc problems, including: degeneration, herniations, bulges and disc prolapses.
When the center gel leaks through the disc, it causes inflammation as it travels through the torn annular rings, because the disc perceives the leaking "nucleus pulposus" gel as a foreign substance, as if it didn't belong in our body. Therefore the outer annulus fights the leaking gel, causing painful inflammation. When the gel leaks outside the disc onto spinal nerve roots, it causes sciatica leg pain or arm pain.
Additionally, if the gel keeps leaking, discs may collapse. This logic led Dr. Pauza to develop the Discseel® Procedure. "The Fibrin sealant was necessary because we can't sew a torn disc. It would be similiar to attempting to sew crab meat," said Pauza. The Fibrin sealant is called a natural bio-adhesive glue, sealing annular tears while the body doesn't reject it as a foreign substance, which is why the Discseel® Procedure works.
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Annular tears are the root of spine pain. The first complaint is low back pain. As disc tears progressively worsen, they leak and lead to disc herniations, bulges, degeneration and desiccation.
Factors associated with annular tears include:
Although low back pain is associated with annular tears, the tears often leak, causing hip and leg pain or numbness (or neck and arm pain and numbness). Formally, these symptoms are called radiculopathy.
Low back pain is most often caused by the disc. Research reveals that it's not just one or two discs, but more often three or more discs and an MRI can't identify the source of pain. Annulograms are necessary to confirm disc annular tears, and that's why MRIs can't diagnose the source of symptoms. Other, less frequent causes of pain include: two small facet joints at each level (also called zygapophsial joints); or the sacro-iliac joints, or muscles and ligaments.
We stopped using discograms years ago, because they're too primative, too painful and not good enough to identify the pain-causing annular tears we want to repair. Discograms are painful because they inject contrast into discs to pressurize discs.
Annulograms are relatively painless, because they inject a very small amount of contrast into each disc's outer annulus, identifying disc tears and where the tears leak. (Some consider disc annulograms analagous to coronary arteriograms, in that they both demonstrate how contrast flows. For example, the annulogram demonstrates how contrast flows through disc tears, and in comparison, coronary arteriograms demonstrates how contrast flows through a heart's coronary arteries).
Annular tears have low, but real potential, to heal on their own, but requires a significant amount of downtime (1.5-2 years on average). It's a slow healing process, if they do heal at all, because there's limited to no blood supply to discs. Instead discs get nourishment and rid themselves of waste products through the process of osmosis through the disc's endplates from above and below.
Conservative options are often prescribed, yet none has been shown to heal torn discs: