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Arthritis and Rheumatism

Annular tear and cortizone injections

04/11/2007

Question:

On March 25, 2005 I received an evaluation of my spinal MRI, in writing. It stated that my cervical spine had "moderate degenerative changes noted in the form of discogenic spondylosis at C4/5, C5/6 and C6/7." In my lumbar spine it stated that there was "mild to moderate disc bulges vs. herniations noted at every level, which is more pronounced at L1/2 and L2/3 (4-5mm in size) with indentations into the spinal cord/thecal sac. Mild to moderate marrow signal change are noted at L2/3, a disc protrusion is noted at L4/5. An HIZ sign is noted which may indicate acute annular tear. Facet arthrosis is noted throughout the spine. My doctor would not explain this, and said he wanted to inject cortisone in my lumbar spine at L4/5. What is an annular tear, and is this safe? Please explain why so much of my spine is affected and what everything means. My upper back is stiff also and limits my movement, but the doctor ignored these symptoms and did not tell me what was wrong. Please advise as to the course of treatment and cause of these problems. I am a female-age 52.

Answer:

In short, the MRI suggests a combination of osteoarthritis (OA) and intervertebral disc pathology. The word spondylosis refers to spinal degenerative arthritis, aka spinal osteoarthritis. Facet arthrosis refers to degenerative arthritis of the joints of the vertebrae (back bones). The intervertebral discs between the vertebrae have an outer layer called the annulus fibrosis (annulus) and an inner layer called the nucleus pulposus (nucleus). With loading on the discs, the discs may bulge or even herniate. Disc bulging may not necessarily cause symptoms, particularly if the bulging disc does not cause any spinal cord or nerve root compression. Disc herniations may cause symptoms if there is compression on the spinal cord or nerve roots or may cause symptoms due to the disc itself. A tear of the annulus may be a precursor to herniation of the disc nucleus.

Medical diagnosis and care is not solely based on an imaging report. In the case of back pain, the imaging studies should complement the history and physical exam. The imaging studies may be overly sensitive and anatomic abnormalities found on MRI may not necessarily correlate with the type of pain that you are having. Your health care providers will attempt to target therapy towards imaging abnormalities that correspond with your clinical history and that would have a likelihood of successful outcome with intervention.

If you're uncertain of your options or would like more time discuss options then you certainly could schedule another appointment with your physician. Alternatively, you may seek a second opinion.

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Response by:

Raymond  Hong, MD, MBA, FACR Raymond Hong, MD, MBA, FACR
Formerly, Assistant Professor of Medicine
School of Medicine
Case Western Reserve University