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Causes of Annular Tears

To understand what annular tears are and how they develop, it is important to cover the basics of the spine’s anatomy. The spine is made up of 33 vertebrae, which are small circular bones that allow spinal movements like bending and twisting. These bones are separated by intervertebral discs, which are small “cushions” of cartilage that act as shock absorbers. 

Each vertebral disc has two main components:

  • The annulus fibrosus – A strong outer layer made up of fibrous cartilage
  • The nucleus pulposus – The inner, gel-like substance protected by the annulus fibrosus


Together, these components distribute the weight during movement, prevent bones from rubbing against each other, and absorb shock. If you suffer an annular tear, the outer layer of the intervertebral disk will start to break down or crack, which might cause the nucleus pulposus to start protruding or bulging.

Annular tears are more common in the neck and lower back, and they may be the result of different causes and risk factors. Let’s look at these factors below. 

Aging-Related Degeneration

Annular tears are often caused by the natural degeneration of the intervertebral discs, which happens due to aging. As we get older, these cartilaginous discs become drier and less flexible, which makes them more prone to cracks and tears.

Repetitive Stress 

Although annular tears may affect anyone at any age, they are more common among people whose occupations, sporting activities, or hobbies involve repetitive, forceful movements. Over time, high-impact activities such as lifting weights, manual labor, or operating heavy machinery can add excessive stress to the intervertebral discs, thus leading to premature degeneration of the cartilage. 

Direct Trauma

Some traumatic events, such as falls, car accidents, or whiplash injuries can affect the spine’s mechanical function. This may change how weight is distributed on the intervertebral discs, adding excessive pressure to areas of the annulus fibrosus, and making tears more likely. Direct trauma could also put the intervertebral discs under sudden strain, which can cause the nucleus pulposus to leak out of the disc.

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Symptoms of Annular Tears

Annular tears have been seen to be present in up to 52% of patients with lower back pain. At first, this condition might seem asymptomatic. However, as the degeneration of the intervertebral disc advances, you may begin to experience severe pain, stiffness, and muscle spasms. If the nucleus pulposus starts protruding from the disc, annular tears can lead to severe complications, such as spinal nerve compression or spinal stenosis. 

Learning to recognize the early symptoms of annular tears can help you find the best line of treatment for your condition. Here is what you need to know.

Back Pain

One of the most common symptoms of annular tears is back pain. The severity of back pain is linked to the level of degeneration of the intervertebral disc and the location of the tear. 

Generally, annular tear pain affects the lower back or the neck area and can be described as dull or aching. The pain can radiate from the back into the arms and legs and intensify with physical activity. You may also experience sharp painful or burning sensations when the discs are under pressure, which happens often during sitting, bending, lifting, sneezing, or coughing.

Muscle Twitching and Spasms 

Muscle twitching and spasms are common complications of annular tears that occur when the nucleus pulposus starts to bulge. 

When this happens, the gel-like structure starts protruding into the spinal cord, which can press on and restrict the passageway that houses the spinal nerves. This prevents the nerves from carrying signals relating to movement from the extremities to the brain and vice-versa. The disruption in nerve signaling can cause involuntary muscle movements, such as twitching or spasms.

Numbness and Tingling 

Another consequence of the nucleus pulposus protruding from the intervertebral disc and pressing on the spinal nerve is a sensation of numbness in the arms, hands, or legs (depending on which area of the spine is affected). 

This symptom occurs when the sensory nerves in the spine are unable to carry signals relating to touch, temperature, or vibration from the limbs and extremities to the brain.


Annular tears can lead to inflammation, especially if the bones, ligaments, and tendons surrounding the vertebrae are exposed to shock and friction during movement. Inflammation involves a build-up of fluids in the affected area, which causes swelling, stiffness, and difficulty of movement.


Regenerative Treatment Options for Annular Disc Tears

Cracks and tears in the annulus fibrosus are subjected to a slow healing process. Since these components of the spine receive a limited supply of blood, oxygen, and nutrients, they can take between 18 months and 2 years to heal an injury. 

So, while you might have considered pain-relievers and non-steroidal anti-inflammatory drugs to ease low back and neck pain, these lines of treatment may not be safe or sustainable in the long term. 

Fortunately, thanks to the advances in regenerative medicine, you can now access a treatment option that leverages the body’s own healing power: regenerative orthopedic treatments. Let’s look at the therapies offered at Orthagenex to provide patients with personalized treatment programs.

Super-Concentrated PRP for Annular Tears

Platelet-rich plasma (PRP) refers to autologous blood samples that have been processed to have platelet concentrations that are 10-40 times higher than baseline levels using a laboratory setting. The use of PRP in regenerative medicine has received significant interest, due to its ability to deliver high concentrations of growth factors precisely and non-invasively to an area in need.

PRP procedures involve injecting the body’s own healing factors (platelets) into the injured tissue using image guidance with fluoroscopy and MSK ultrasound. This procedure can be used to treat a variety of orthopedic conditions, including joint instability, minor arthritis, ligament, and tendon injuries, and strains.

More than 30 randomized controlled trials have been carried out on the effectiveness of PRP to support the body’s ability to heal naturally by stimulating the stem cells within the targeted area.

Bone Marrow Concentrate Injections for Disc Tears

Stem cells are an essential component of the human body and play an important role in the repair of injured bones, ligaments, tendons, and other tissues. However, when we age or suffer an injury, the body may become unable to deliver enough cells to the area in need.

To help with this, bone marrow concentrate procedures at Orthagenex use imaging guidance to deliver concentrated bone marrow containing stem cells to the area in need. This encourages the body’s inherent ability to heal itself by replenishing cell population in the injured area.

In practice, bone marrow concentrate procedures are carried out by cannulating the bone near the pelvis with a trocar, a sharp-tipped device. This provides a narrow tunnel that can be used to collect samples of the bone marrow’s liquid component, which is rich in stem cells.

BMC procedures can assist patients in improving their spinal health and mobility without the lengthy and painful rehabilitation periods associated with surgery.



Annular tears can be extremely painful and can impact your life for up to two years at a time. Because of this, looking beyond medications to find an efficient treatment option is essential to avoid exposing yourself to unnecessary side effects and to regaining your spine’s health. 

At Orthagenex, we can help each patient access a personalized treatment program that combines high-dose BMA and high-dose PRP procedures.

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