Annular Tear

An annular tear develops in the annulus of an intervertebral disc. They develop gradually as we age. Tiny tears and fissures can develop and spread through the soft tissue of the nucleus pulposus. Eventually, the tears will irritate the outer third of the disc which contains several nerves. The pain may at first be acute and gradually become chronic, and quite irritating. An annular tear can be concentric, transverse, or radial and can involve all layers of the annulus.

Your vertebral discs serve as shock absorbers, cushioning the spinal column. Not surprisingly, losing the structural support of a disc will cause pain which will intensify with movement. Occasionally, the annular tear will stimulate the transversing nerve and cause a form of pain called radiculopathy which is felt in your arms and legs.

At times, a fissure can cause an extrusion or herniation of the annulus fibrosus, a sturdy ring of fibers that contains the soft center. A herniation can place significant pressure on the nerves adjacent to the vertebrae. If herniation has occurred, you can be sure that an annular tear or an annular fissure was present.

Many annular tears will not cause any pain and will heal on their own, but some tears can be quite painful especially if they are located in the outer third of the disc’s annular ring. For patients over sixty, annular tears can also be an early sign of degenerative disc disease caused by osteoarthritis.

How is an annular tear evaluated?
An MRI is often the best choice for identifying an annular tear. It allows your spinal doctor to assess the size of a tear and whether it is concentric, transverse or radial in its orientation.

A CT scan will identify nerve roots or spinal cord compression, but it may not identify edema in the disc and the tell-tale signs of fissures or tears that have not yet caused herniations which is why an MRI is most often used.

How is an annular tear treated?
Doctor Nourian has a wide range of non-invasive, non-opioid pain relief strategies that can bring welcome relief to the pain caused by annular tears.

An annular tear is an indicator that degenerative disc disease may be starting. There are several integrative medical techniques that reduce acute and chronic pain and slow disc degeneration.

Pain is real, but Dr. Melamed has developed a way to control it by taking a holistic approach that includes non-surgical therapies based on Integrative Medicine techniques, lifestyle optimization, and starting an anti-inflammatory diet program.

Most patients respond well to these holistic solutions, but some patients may not. If surgery is your best choice, Dr. Melamed may request additional imaging tests. He will review the most appropriate surgical options and discuss the therapeutic benefits of his Opiate-Free Surgery and Pain Management System which has helped hundreds of patients recover from back pain and avoid potential addiction problems during the recovery phase.

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What Patients Think About Dr. Nourian

Awesome awesome doctor!!!very nice to all his patient! Dr. Nourian is very kind and caring. A very pleasant man and easy to communicate with. He saw my son when he injured his hip and He took extra good care of him. After 2 wks he was able to resume sports. He’s not only a very good orthopedic surgeon but also an amazing Spine doctor. He always make sure he always gets the job done. 2 Thumbs up to this Doctor!!!??

Regz Ramos


Dr. Nourian was fantastic! He was able to alleviate my back pain. I would recommend him to anyone

Nikesh Patel


Dr. Nourian is the best. His bedside manner is friendly and professional and his staff is excellent. I went to see him after a terrible whiplash injury when I rear-ended while driving. After receiving my MRI results, the doctor was quick to reach out and went over my options with me. He really cares about his patients.

Michelle Sadighpour Shophet


Dr. Nourian is an outstanding physician. I injured my back while exercising recently. I went to see him, and he explained my injury to me in detail. He told me that my injury would most likely heal without surgery, but if I needed surgery in the future he would get me through it. He is honest, intelligent, and forthcoming. I am thankful for him as my spine physician.

Michael Broukhim


Dr. Nourian was absolutely fantastic. I was struggling with intense lower back pain. He took his time 40 minutes to be exact to see me and review everything with me after another follow up we decided to do surgery. Thank god!!! I’m back to working out, picking up my child, and living my best life. I was so hesitant to do surgery but he was a true god send. He would call me weekly to see how I’m doing.

Sara Sadig


Dr. Nourian is smart, caring, attentive and super knowledgeable. I highly recommend him as an orthopedic surgeon!

Sharon Darouvar Greiner


Great with patients and consciences of patient’s time as well as needs. He will spend time to assure the patients with respect to treatment plan and follow-up was amazing with my auntie’s back issues.

Connie Esparza


An extremely knowledgeable doctor with wonderful bedside manner. He clearly explained every step of the procedure and eased all my worries. My back is feeling great thanks to Doctor Nourian

Ashley Sadig


After seeing three doctors and all of them saying I should operate Dr Nourian was able to address and issue without and surgery. I got an epidural and did physical therapy and I’m able to run around with my grand child. He’s truly a gem. Everyone at the office was friendly and supportive.

Katrin Sadighpour


Dr. Nurian explained everything very well and preformed the surgery exactly as planned. I woke up pain free and the surgery pain was gone in five days. Could not give him enough praise.

Wade Savage