Annular fissure
Updates to Article Attributes
Annular fissures are a degenerative deficiency of one or more layers that make up the annulus fibrosus of the intervertebral disc.
Terminology
Many authors prefer the term annular fissureover annular tear,as the latter seems to imply acute injury 1,2. In the setting of severe trauma with disruption of the disc, then the term disc rupture should be used. The term annular gap (referring to a relatively wide annular fissure) is non-standard 2.
Clinical presentation
Most are asymptomatic, however, some are painful. The defect allows ingrowth of nerve endings and granulation tissue. Fissures near the dorsal root ganglion are especially likely to be painful.
Pathology
Annular fissures may be radial, transverse or concentric in orientation. The fissure may involve all layers or only some. The distinction is difficult if no disc extrusion is seen.
Radiographic features
Fluoroscopy
Discography (introduction of contrast into the nucleus pulposus) can help distinguish partial thickness or full thickness annular fissure, although the clinical relevance of this is disputed.
MRI
Although very common, only a minority are identified on MRI and are characterised by a region of high T2 signal (high intensity zone) in the otherwise low signal annulus.
-<p><strong>Annular fissures</strong> are a degenerative deficiency of one or more layers that make up the <a href="/articles/annulus-fibrosus">annulus fibrosus</a> of the <a href="/articles/intervertebral-disc">intervertebral disc</a>. </p><h4>Terminology</h4><p>Many authors prefer the term <strong>annular fissure</strong><em> </em>over <strong>annular tear</strong>,<em> </em>as the latter seems to imply acute injury <sup>1,2</sup>. In the setting of severe trauma with disruption of the disc, then the term <strong><a href="/articles/disc-rupture">disc rupture</a></strong> should be used. The term <strong>annular gap</strong> (referring to a relatively wide annular fissure) is non-standard <sup>2</sup>. </p><h4>Clinical presentation</h4><p>Most are asymptomatic, however, some are painful. The defect allows ingrowth of nerve endings and granulation tissue. Fissures near the <a href="/articles/dorsal-root-ganglion">dorsal root ganglion</a> are especially likely to be painful.</p><h4>Pathology</h4><p>Annular fissures may be radial, transverse or concentric in orientation. The fissure may involve all layers or only some. The distinction is difficult if no disc extrusion is seen.</p><h4>Radiographic features</h4><h5>Fluoroscopy</h5><p><a href="/articles/discography">Discography </a>(introduction of contrast into the <a href="/articles/nucleus-pulposus">nucleus pulposus</a>) can help distinguish partial thickness or full thickness annular fissure, although the clinical relevance of this is disputed.</p><h5>MRI</h5><p>Although very common, only a minority are identified on <a href="/articles/mri-2">MRI</a> and are characterised by a region of high T2 signal (high intensity zone) in the otherwise low signal annulus. </p>- +<p><strong>Annular fissures</strong> are a degenerative deficiency of one or more layers that make up the <a href="/articles/annulus-fibrosus">annulus fibrosus</a> of the <a href="/articles/intervertebral-disc">intervertebral disc</a>. </p><h4>Terminology</h4><p>Many authors prefer the term <strong>annular fissure</strong><em> </em>over <strong>annular tear</strong>,<em> </em>as the latter seems to imply acute injury <sup>1,2</sup>. In the setting of severe trauma with disruption of the disc, then the term <strong>disc rupture</strong> should be used. The term <strong>annular gap</strong> (referring to a relatively wide annular fissure) is non-standard <sup>2</sup>. </p><h4>Clinical presentation</h4><p>Most are asymptomatic, however, some are painful. The defect allows ingrowth of nerve endings and granulation tissue. Fissures near the <a href="/articles/dorsal-root-ganglion">dorsal root ganglion</a> are especially likely to be painful.</p><h4>Pathology</h4><p>Annular fissures may be radial, transverse or concentric in orientation. The fissure may involve all layers or only some. The distinction is difficult if no disc extrusion is seen.</p><h4>Radiographic features</h4><h5>Fluoroscopy</h5><p><a href="/articles/discography">Discography </a>(introduction of contrast into the <a href="/articles/nucleus-pulposus">nucleus pulposus</a>) can help distinguish partial thickness or full thickness annular fissure, although the clinical relevance of this is disputed.</p><h5>MRI</h5><p>Although very common, only a minority are identified on <a href="/articles/mri-2">MRI</a> and are characterised by a region of high T2 signal (high intensity zone) in the otherwise low signal annulus. </p>
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