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Anular Fissure, Intervertebral Disc
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Anular defect; high-intensity zone (HIZ) in posterior anulus
                • Term "tear" is nonstandard and may inaccurately imply acute traumatic etiology rather than typical cause of repetitive stress
            • Definitions

              • Disruption of concentric collagenous fibers comprising anulus fibrosus

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Other Modality Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Eck JC et al: Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 6: discography for patient selection. J Neurosurg Spine. 21(1):37-41, 2014
                                            2. Fardon DF et al: Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the north american spine society, the american society of spine radiology, and the american society of neuroradiology. Spine (Phila Pa 1976). 39(24):E1448-65, 2014
                                            3. Sharma A et al: Association between annular tears and disk degeneration: a longitudinal study. AJNR Am J Neuroradiol. 30(3):500-6, 2009
                                            4. Bartynski WS et al: Postdiskogram CT features of lidocaine-sensitive and lidocaine-insensitive severely painful disks at provocation lumbar diskography. AJNR Am J Neuroradiol. 29(8):1455-60, 2008
                                            5. Lander PH: Lumbar discography: current concepts and controversies. Semin Ultrasound CT MR. 26(2):81-8, 2005
                                            6. Munter FM et al: Serial MR Imaging of Annular Tears in Lumbar Intervertebral Disks. AJNR Am J Neuroradiol. 23(7):1105-9, 2002
                                            7. Slipman CW et al: Side of symptomatic annular tear and site of low back pain: is there a correlation? Spine. 26(8):E165-9, 2001
                                            8. Weishaupt D et al: Painful lumbar disk derangement: relevance of endplate abnormalities at MR imaging. Radiology. 218(2):420-7, 2001
                                            9. Schollmeier G et al: Observations on fiber-forming collagens in the anulus fibrosus. Spine. 25(21): 2736-41, 2000
                                            10. Ahn JM et al: Peripheral focal low signal intensity areas in the degenerated annulus fibrosus on T2-weighted fast spin echo MR images: correlation with macroscopic and microscopic findings in elderly cadavers. Skeletal Radiol. 28(4):209-14, 1999
                                            11. Mercer S et al: The ligaments and annulus fibrosus of human adult cervical intervertebral discs. Spine. 24(7): 619-26; discussion 627-8, 1999
                                            12. Ito M et al: Predictive signs of discogenic lumbar pain on magnetic resonance imaging with discography correlation. Spine. 23(11):1252-8; discussion 1259-60, 1998
                                            13. Saifuddin A et al: The value of lumbar spine magnetic resonance imaging in the demonstration of anular tears. Spine. 23(4):453-7, 1998
                                            14. Stadnik TW et al: Annular tears and disk herniation: prevalence and contrast enhancement on MR images in the absence of low back pain or sciatica. Radiology. 206(1):49-55, 1998
                                            15. Vernon-Roberts B et al: Pathogenesis of tears of the anulus investigated by multiple-level transaxial analysis of the T12-L1 disc. Spine. 22(22):2641-6, 1997
                                            16. Wood KB et al: Magnetic resonance imaging of the thoracic spine. Evaluation of asymptomatic individuals. J Bone Joint Surg Am. 77(11):1631-8, 1995
                                            17. Bogduk N et al: The innervation of the cervical intervertebral discs. Spine. 13(1): 2-8, 1988
                                            18. Yu SW et al: Tears of the anulus fibrosus: correlation between MR and pathologic findings in cadavers. AJNR Am J Neuroradiol. 9(2):367-70, 1988
                                            19. Pooni JS et al: Comparison of the structure of human intervertebral discs in the cervical, thoracic and lumbar regions of the spine. Surg Radiol Anat. 8(3):175-82, 1986
                                            20. Johnson EF et al: The distribution and arrangement of elastic fibres in the intervertebral disc of the adult human. J Anat. 135 (Pt 2): 301-9, 1982
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Anular defect; high-intensity zone (HIZ) in posterior anulus
                                                          • Term "tear" is nonstandard and may inaccurately imply acute traumatic etiology rather than typical cause of repetitive stress
                                                      • Definitions

                                                        • Disruption of concentric collagenous fibers comprising anulus fibrosus

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Other Modality Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Eck JC et al: Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 6: discography for patient selection. J Neurosurg Spine. 21(1):37-41, 2014
                                                                                      2. Fardon DF et al: Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the north american spine society, the american society of spine radiology, and the american society of neuroradiology. Spine (Phila Pa 1976). 39(24):E1448-65, 2014
                                                                                      3. Sharma A et al: Association between annular tears and disk degeneration: a longitudinal study. AJNR Am J Neuroradiol. 30(3):500-6, 2009
                                                                                      4. Bartynski WS et al: Postdiskogram CT features of lidocaine-sensitive and lidocaine-insensitive severely painful disks at provocation lumbar diskography. AJNR Am J Neuroradiol. 29(8):1455-60, 2008
                                                                                      5. Lander PH: Lumbar discography: current concepts and controversies. Semin Ultrasound CT MR. 26(2):81-8, 2005
                                                                                      6. Munter FM et al: Serial MR Imaging of Annular Tears in Lumbar Intervertebral Disks. AJNR Am J Neuroradiol. 23(7):1105-9, 2002
                                                                                      7. Slipman CW et al: Side of symptomatic annular tear and site of low back pain: is there a correlation? Spine. 26(8):E165-9, 2001
                                                                                      8. Weishaupt D et al: Painful lumbar disk derangement: relevance of endplate abnormalities at MR imaging. Radiology. 218(2):420-7, 2001
                                                                                      9. Schollmeier G et al: Observations on fiber-forming collagens in the anulus fibrosus. Spine. 25(21): 2736-41, 2000
                                                                                      10. Ahn JM et al: Peripheral focal low signal intensity areas in the degenerated annulus fibrosus on T2-weighted fast spin echo MR images: correlation with macroscopic and microscopic findings in elderly cadavers. Skeletal Radiol. 28(4):209-14, 1999
                                                                                      11. Mercer S et al: The ligaments and annulus fibrosus of human adult cervical intervertebral discs. Spine. 24(7): 619-26; discussion 627-8, 1999
                                                                                      12. Ito M et al: Predictive signs of discogenic lumbar pain on magnetic resonance imaging with discography correlation. Spine. 23(11):1252-8; discussion 1259-60, 1998
                                                                                      13. Saifuddin A et al: The value of lumbar spine magnetic resonance imaging in the demonstration of anular tears. Spine. 23(4):453-7, 1998
                                                                                      14. Stadnik TW et al: Annular tears and disk herniation: prevalence and contrast enhancement on MR images in the absence of low back pain or sciatica. Radiology. 206(1):49-55, 1998
                                                                                      15. Vernon-Roberts B et al: Pathogenesis of tears of the anulus investigated by multiple-level transaxial analysis of the T12-L1 disc. Spine. 22(22):2641-6, 1997
                                                                                      16. Wood KB et al: Magnetic resonance imaging of the thoracic spine. Evaluation of asymptomatic individuals. J Bone Joint Surg Am. 77(11):1631-8, 1995
                                                                                      17. Bogduk N et al: The innervation of the cervical intervertebral discs. Spine. 13(1): 2-8, 1988
                                                                                      18. Yu SW et al: Tears of the anulus fibrosus: correlation between MR and pathologic findings in cadavers. AJNR Am J Neuroradiol. 9(2):367-70, 1988
                                                                                      19. Pooni JS et al: Comparison of the structure of human intervertebral discs in the cervical, thoracic and lumbar regions of the spine. Surg Radiol Anat. 8(3):175-82, 1986
                                                                                      20. Johnson EF et al: The distribution and arrangement of elastic fibres in the intervertebral disc of the adult human. J Anat. 135 (Pt 2): 301-9, 1982