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Spine and Back Health

Annular Tear

12/10/2009

Question:

Hello,

2 years ago I slipped and fell on ice going down my driveway. Significant whiplash to my neck. I believe that C5-C6 is the area of concern. I have had 3 cycles of physical therapy, facet joint cortisone injections, acupuncture and 6 treatments of prolotherapy injections-to address soft tissue ligament/joint capsule injury. MRI is essentially negative other than minimal bilateral uncovertebral joint hypertrophy. I feel that I have ruled out overything other than an annual tear-torn disc, which will not show up on MRI unless a disc herniation is present. Have you seen many annual tears in the neck where a discogram and subsequent IDET procedure (intradiscal electrothermal therapy) has been succesful? A previous posting stated that annual tears can heal on their own. My research indicates that the healing may actually lead to a herniate disc down the road or the scar tissue heals into the painful nerve fibers thus creating aggravation imminent and permanent. I would appreciate any advice you may have and thank you in advance.

Answer:

Hello, thank you for your question. Unfortunately, much less is known about annular tears in the cervical spine than in the lumbar spine, and the normal course of events is probably not the same between the two. It is actually not true that an annular tear won't show up on MRI without a disc herniation, although it very well might be difficult to see or could be missed in some cases. Whether a tear can heal on its own in the C-spine is difficult to predict. Cervical discography is highly controversial, and I most certainly do not recommend an IDET procedure for anyone. IDET causes significant disc damage in the long run and there is little or no evidence to suggest it can treat neck pain. As with any injury (or intervention), things don't heal properly 100% of the time, and the kinds of problems you mentioned can occur whether you undergo a treatment or just let it heal on its own. I hope this helps address some of the issues you've raised. As always, we do NOT attempt to diagnose people or recommend treatments for them on this website, but simply hope to educate. Good luck.

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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