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
Chelala L et al: Positive predictive values of lumbar spine magnetic resonance imaging findings for provocative discography. J Comput Assist Tomogr. 43(4):568-71, 2019
Brinjikji W et al: Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 36(4):811-6, 2015
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
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
Sharma A et al: Association between annular tears and disk degeneration: a longitudinal study. AJNR Am J Neuroradiol. 30(3):500-6, 2009
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
Lander PH: Lumbar discography: current concepts and controversies. Semin Ultrasound CT MR. 26(2):81-8, 2005
Munter FM et al: Serial MR imaging of annular tears in lumbar intervertebral disks. AJNR Am J Neuroradiol. 23(7):1105-9, 2002
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
Weishaupt D et al: Painful lumbar disk derangement: relevance of endplate abnormalities at MR imaging. Radiology. 218(2):420-7, 2001
Schollmeier G et al: Observations on fiber-forming collagens in the anulus fibrosus. Spine. 25(21): 2736-41, 2000
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
Mercer S et al: The ligaments and annulus fibrosus of human adult cervical intervertebral discs. Spine. 24(7): 619-26; discussion 627-8, 1999
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
Saifuddin A et al: The value of lumbar spine magnetic resonance imaging in the demonstration of anular tears. Spine. 23(4):453-7, 1998
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
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
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
Bogduk N et al: The innervation of the cervical intervertebral discs. Spine. 13(1): 2-8, 1988
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
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
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
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References
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KEY FACTS
Terminology
Imaging
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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
Chelala L et al: Positive predictive values of lumbar spine magnetic resonance imaging findings for provocative discography. J Comput Assist Tomogr. 43(4):568-71, 2019
Brinjikji W et al: Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 36(4):811-6, 2015
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
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
Sharma A et al: Association between annular tears and disk degeneration: a longitudinal study. AJNR Am J Neuroradiol. 30(3):500-6, 2009
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
Lander PH: Lumbar discography: current concepts and controversies. Semin Ultrasound CT MR. 26(2):81-8, 2005
Munter FM et al: Serial MR imaging of annular tears in lumbar intervertebral disks. AJNR Am J Neuroradiol. 23(7):1105-9, 2002
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
Weishaupt D et al: Painful lumbar disk derangement: relevance of endplate abnormalities at MR imaging. Radiology. 218(2):420-7, 2001
Schollmeier G et al: Observations on fiber-forming collagens in the anulus fibrosus. Spine. 25(21): 2736-41, 2000
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
Mercer S et al: The ligaments and annulus fibrosus of human adult cervical intervertebral discs. Spine. 24(7): 619-26; discussion 627-8, 1999
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
Saifuddin A et al: The value of lumbar spine magnetic resonance imaging in the demonstration of anular tears. Spine. 23(4):453-7, 1998
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
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
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
Bogduk N et al: The innervation of the cervical intervertebral discs. Spine. 13(1): 2-8, 1988
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
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
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
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