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Spine and Back Health

Healing of internal annular tears

01/27/2009

Question:

I understand that the tear in the outer 1/3 annulus can heal itself but not in inner 2/3 becasue of lack of vascular penetration according to research. If the annulus is living tissue, then why can it not lay down tissue to heal itself if it can obtain nutrients from the surrounding fluid. This question is in respect to a disc extrusion that is causeing no pain now after 6 weeks and has regressed on its own. If I support the healing process, will it heal over time ie. the full extent of the tear so as to prevent a herniation.

Answer:

Hello, thank you for your question. The truth is, we don’t fully understand the process of disc healing, partly because we don’t really fully understand the normal physiology and biomechanics of the disc. I would say you slightly misquoted the conclusions of the research – it’s not that the inner part of the annulus can’t heal itself, but it might be less likely to because of the relatively poor vascular supply.

I think the really relevant question as it relates to your question about healing after a disc herniation / extrusion is: How fully does the disc annulus have to heal in order to prevent (or reduce the chance of) another disc herniation? Once again, there’s no definitive answer out there. What we do know is that if a disc has herniated once, there is a certain likelihood that it will do so again in the future. That risk can be modified by adhering to a healthy diet, carefully strengthening the back and abdominal muscles, avoiding excessive strain and sheer forces on one’s back (i.e., heavy lifting, bending and twisting repetitively), not smoking, etc. Nevertheless, even people who do these things sometimes suffer recurrent herniations.

In the end, the question of why some injuries heal in some people and not in others is always multi-factorial, and hard to predict. I’m sorry there isn’t a more definitive answer for you. Good luck and good health to you.

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Response by:

David J Hart, MD David J Hart, MD
Associate Professor of Neurosurgery
School of Medicine
Case Western Reserve University