Annular tear

Posted By Ron on October 16, 1998 at 11:03:24:







ALAS!!!
After a few weeks of research I think I have come upon something and
I have a few questions.
I have posted here before and have got wonderful suggestions.  I have been
seeing a Physiatrist for about 5 months for a horrible lower right back pain,
with referred pain into the groin and leg.  The back pain is the primary pain.
They have treated me right by the book but all tests are negative.
(MRI, bone scan, CT abdomen, EMG) I found the following information
on the internet:
Annular Tear;

- Discussion:
- lesion labeled annuular tear or internal disruption is based on
      concept of leaking disc, one which permits the irritating liquid
      material normally restricted to the center of the disc to come into
      contact with the innervated tissue;
- annular tissue that permits egress of this liquid has a poor capacity
      for healing;
- at most, a thin layer of scar tissue at the periphery of the tear may
      seal the leak but leave the disc highly susceptible to retearing;
- where as herniated disc has a significant capacity to be resolved w/
      time, annular tear continues to produce symptoms indefinitely;
- clinical picture is based on pain related to increased intradiscal
      pressure and irritability of neural structures;
- annular tear is usually produced by injury that increases intradiscal
      pressure significantly;
- predominant element in the history is back pain, either alone or in
      exess of leg pain;
- leg pain may be either unilateral or bilateral;
- increases in intradiscal pressure exacerbate the pain;
- pain is often worse when sitting than when standing;
- coughing & sneezing worsen the pain as do forward bending and lifting;
- on PE no nerve compression is evident;
- key finding is positive sciatic stretch test that produces back pain
      or back pain greater than leg pain;
- positive test is presummably produced by tension on irritated dural
      tissue or possibly by increased intradiscal pressure;
- myelogram, MRI, & CT, tests show no compression of neural structures;
- key test is discography with CT discography;
- positive examination will show dye extending into the epidural space
      or extending to the periphery of the disc where it can contact
      innervated portion of the annulus fibrosus;
- posiitve test also requires a reproduction of pain accompanying
      injection of dye;
- back pain alone or back pain greater than leg pain;
- increased back pain with increased intradiscal pressure;
- reproduction of back pain to greater degree than leg pain by sciatic
      stretch test;
- no neurologic deficit;
- reproduction of pain by discography and discographic dye extending to
      or beyond the periphery of the annulus fibrosis;
I FIT THIS PROFILE ALMOST 100%- I just found this yesterday and have not
mentioned it to my Doctor.  I have not had a Discogram but my questions
are as follows:
1.  Is it necessary to have a Discogram to find this,  because if the
treatment does not change,  why go thru the pain?
2.  What is the treatment for an annular tear if indeed this is what I have?
Is is always non-surgical,  surgical?
3.  Can a person recover fully from an annular tear,  or will I have to
rely on pain management the rest of my life??
4.  Are there any publications which may discuss annular tears in greater
detail.  I live in a small Indiana city where there is no major
medical school,  so I have limited access to a medical library.
My mother lives in Cleveland,  if indeed this is what I have does
it make sense to visit you folks at the Cleveland clinic?
Thank you so much,
Ron