Annular Tear L5/S1
 

I'm looking for some advice or experience with Annular Tears. I have a Tear at L5/S1 which happened during 8/2009. I do all the right things. I eat right (lost 25 pounds), Core, stretch and strengthening exercises daily and do no bending, twisting or heavy lifting. I have a Teeter Inversion table and hang upside down like a bat daily.

The pain is primarily sciatica down my left leg. Back side of thigh to top of foot. It's fairly constant, but fluctuates in degree of pain. It's odd that my tear is center to right, but my symptoms are left leg. Very little back pain. MRI showed the tear (Hiz), but no compression and good disk height.

Does anyone have any experience or know of anyone that has had success with Annular Tears? Do they or can they really heal as the medical community states. Haven't seen a chiropractor, don't think they have anything to offer. However I could be wrong, do they have any "magic bullets"?

I'm hoping surgery is not in my future. However from my research it looks like ADR or Fusion is the only treatment. However my Ortho. surgeon who did my cervical fusions and Stenum repairs suggested if needed, he could do a micro discectomy and remove the troubled area.

Any help is appreciated.

PS - Just to save time from any WEB site suggestions. I have seen every WEB site imaginable about tears, including chirogeek.

Hello,

I have lots of experience with annular tears and I have read lots of scientific literature about this issue.

My recommendations would be:
1. Finding a good "minimally-invasive" spine surgeon
2. Doing discography (nobody will do any treatment for annular tear until they confirm pain with discography)
3. Depending on tear size trying to shrink the disc and seal tear with laser (PLDD). Alternatively, biacuplasty sounds like a good solution. No experience with biacuplasty though.
4. If tear is bigger, then endoscopic treatment is next step
5. If tear is unsolvable my this two minimally-invasive methods, solutions are ADR or fusion. This step also includes finding a good surgeons in your area that is skilled for this types of surgeries.

Considering you suffer from 2009, I think chances of tear healing are small! I think micro-discectomy is not a good step for annular tears, especially based on literature I've read.

All best

i have my lower back pain for almost 10 years. finaly this year i was diagnosed with right diagnose. Degenerative disc desease with annular tear in l4 l5 disc. so in my case,tear didnt heal at all. will go to endoscopy for this. dr will try "heal" tear and remove degeneration parts.
if you have some specified questions, feel free to ask :)

Keano, thank you for the response.

I don't know to much about PLDD. Is the procedure broadly available? Or is it mostly performed out of the U.S or I think a Dr. Cho in Colorado?

I would not consider a Discography unless I was getting ready for surgery. From what I understand there are studies supporting discography, there are also studies showing discography creating pain in asymptomatic disks? So who's right, who's wrong? If it comes to that for me I hope I pick the right one.

I suffered with sciatica since August of 2009. However, every time it settled I did stupid things like lifting a coach, cleaning my basement with lots of twisting and lifting. I did not "taper back" until I got my MRI results earlier this month showing a tear. So not sure if I'm still early in the game or not.

As for time, the only example I have is my doctor had a tear which then turned into a full blown herniation. He was telling me he was in incredible pain for 18 months, did lots of PT (as much as he could stand), changed his diet and at about the 18 months it resolved itself. That was 8 years ago. He may be one of the lucky ones?

I have read medical literature that says most tears resolve in 6 months, up to 2 years and less than 10% require surgery. The problem is finding those who have had a "resolution".

Thanks again for your input and please feel free to share any experiences with me.

Newhere - 10 years is a long time. Sorry to hear you've been living this horror for so long.

What is the condition of your disk? Has in collapsed, impinging on a nerve root? Do you have sciatica symptoms or just low back pain? How was the tear diagnosed, CT, MRI, Discography?

Is your Dr. and Neurosurgeon or Orthopedic?

Thanks in advance.

PLDD is available worldwide for past 25 years. Its primarly used for small herniations but with time and when in experienced hands, it can be a good alternative for endoscopic surgery and micro-discectomy, in carefully selected patients.

You are right. From my point of view there are two issues here:
1. Experience of surgeon who is performing discography
2. Equipment for discography (read: discography should be pressure controled, but OR's rarely have this peace of equipment.

Also, intradiscal steroids post-discography could be a good screening method!

annular tear
 

I've had that has been identified since the mid 90's at L3 and had 3 discograms done between 2001-2005. Had discectomies at L4 and L5S1 in late 80's and early 90's and later around 2001 was looking into ADR. Recomemndations were to do ADR on L4 and L5S1 in 2003 (didn't do it) and then in 2005 to have ADR at L4 and fusion at L5S1 (didn't do it either). Basically pain lessened to the point I didn't feel like having more surgery.

My L3 annular tear showed a disrupted disc but not enough for replacement re ADR. Not sure that would have been the case w/fusion.

Has anyone recommended Epidural steroid injections or selective nerve root blocks (not sure if either are appropriate tho just wondering) I had them 3x/year for about 10 years and got great relief but had much more back pain than leg pain.

I think it's more common for annular tears at L5S1 to progress and become more problematic than at L3. Most of my ESIs were aimed at L4 and L5S1 as did one I think at L3 and it didn't help w/pain at all so discograms must have been right on re identifying pain generating disc levels.

Did you read Doug's story on chirogeek? I had to use the wayback machine to see it.

His was the first story I thought of. In case you didn't see it, I think after a failed microd and about 6 years the pain went away, but he was left with some significant limitations, but could get around ok.

If it is chemical radiculitis, I dont think anyone knows what the future holds for it. Maybe it settles, maybe it doesn't.

Yeah almost 10 years because i have been toold i have some birth-anomality on my spine(didnt research alot about spine so much then) so i think - ok if is a condition from my birth i MUST live with this. I hate so much my stupid dr. because of this. she didnt want send me to a neurosurgeon because she thinks its from the day i born :S...oh man she is so arghhhhh.
Anyway,from my sight, the disc is around 60% damaged because discography gives results of rupture 3/5(or 6). so, mri shows some abnormality on my disc,but to confirm it i do a discography. i dont have sciatica but have veeery bad low back pain. After so much years of chronic low back pain, i will try to resolve it with minimaly invasive procedure called selective endospopic discectomy with annuloplasty,you can google it if you want.....
I must admit i have also strong pain in thoracic area for 2 years now and still i dont know exaxtly source of the pain. cheers :)

I had a Grade 5 annular tear in March of 2010. After my discogram they did a CT Scan and the Grade 5 tear was the finding at L5/S1.

Now my L5/S1 Grade 5 Annular Tear has turned into a large disc extrusion sometime in 2011 (I assume). MRI finding in 3/2011 one year later.

Right now I am heavily researching options and have had LBP since 2008.

Longroad, sorry to hear your tear has progressed.

A few questions if you don't mind, did pain increase with extrusion? Do or did you have good disk height when the tear was discovered? What is your primary symptoms? Where you diligent about doing all the right things, core strengthening, diet, no bending or twisting and lifting heavy objects?

From what I understand that an extrusion has a better chance to heal. But as Hooch said "No one knows what the future holds".

My primary symptom is sciatica, also if I sit for an extended time it makes things worse. I hope I get lucky and this resolves. I made a mistake in my first posting., it was 8/2010 not 8/2009 that this first acted up. So I'm about 8 months into this.

Hooch, I did read Doug's story and his entire WEB site. Very informative.

Maria, I did have 2 epidurals with no success.

The strange things about my situation is that the tear is towards the right at L5/S1, but my symptoms are on the left. I do also have a central herniation at L3/L4 with no neural compression. My pain management Dr. feels my issue is L5/S1, however my Surgeon for my neck reviewed my MRI and said it is possible that L5/S1 is not my problem and the real issue is L3/L4.

My sciatica is not really following either dermatone exactly, it becomes more broad. It does radiate to the top of my foot, not my big toe, or little toe. I know I could get a discogram to get a better picture. But I feel what's the point unless surgery is where I'm headed.

ANy advice from anyone is appreciated.

It is hard to say if the LBP increased. It is different for sure but exactly how I cannot say. For sure the right leg hurts more when I try to extend it out or any stretching to the right leg is painful. The tear was discovered in 2009 with a Lumbar MRI but was not a grade 5 at the time.

Primary symptoms are LBP with right leg pain. I am very diligent and go to the gym at least twice a week for light weight exercises and core strengthening. Try to walk 10,000 steps per day and do PT exercises at home.

Since the nature of my back pain has changed with the 8mm extrusion I am seriously considering a microdiscotomey before fusion/ADR. Realize I may need add'l surgery down the road but by then maybe some of the newer disc will be FDA approved or the treatment for the disc regeneration will be FDA approved.

There are many successful back surgeries and not successful procedures for every procedure I have researched.

LRA,

I agree in trying the disco before more drastic surgeries. You may be one of the lucky ones whose problems stop there. I'm not sorry I had the first disco/lami but it was an emergency situation so I had no choice to consider anything else, not that my doctor recommended anything.

However, when I think about it, I get angry when he recommended the second surgery, knowing full well the chances of success were limited. So just keep it in the back of your mind if this occurs.

CP, it does look like a discogram is in your future. Fear not - the pain last for only seconds, if that long. Also agree that if you're not willing to do anything about it, like surgery, what's the point. Making the right decision - not easy.

My best to both of you, Dale

I really love the post by all the members of the forums. Keep sharing.

Chirogeek is an amazing site with lots of help there.