Anular tear and disc extrusion
This patient had anular tears of L4-5 and L5-S1. The L5-S1 disc was also herniated, of moderate size. The lower two discs also had less water content, indicating some degeneration. There was also some associated disc collapse, as happens when inner disc content is lost in a herniation. The little white dots on the images indicate the tears of the anulus of both discs. You may see this noted as a high-intensity zone or signal, on your MRI report.
You will also see a disc extrusion coming from the L4-5 disc and migrating down behind the vertebral body of L5. The fact that the disc has extruded does not necessarily have any special importance. All that matters is the clinical picture of the patient, i.e. the severity of the pain, the neurological status of the patient, i.e. any weakness or interference with bowel or bladder function, and whether they are improving with non-surgical treatment. This patient’s extrusion was relatively small and right-sided. Extrusions are probably present in about 10% of disc herniations, and in my experience, are no more difficult to treat than non-extruded herniations.
One other disc herniation lesion, not discussed here, are disc fragments. These are pieces of disc material or other material which may disconnect from the disc source and can be very painful. Contents of material can include disc, cartilage, ligament, and even boney material.
Dr. Castanet will also orient you to the position of the patient, and why the axial images are “flipped” in terms of which side is which.
Anular tear and disc extrusion
If I can help you with your low back pain, herniated disc, or anular tear pain, please call me at 404-558-4015.
* There is some debate about the correct spelling of anular vs. annular, so you may see it spelled either way in various places.
