What does it mean to have an annular tear of the mid posterior aspect of the L4-L5 disc space with minimal disc bulging?

Answer 1

This means that the intervertebral disk that sits between your fourth and fifth lumbar vertebrae (lower back) has a weakened wall. The weakened wall is allowing the jelly-like center of your disk to push the wall outward (bulge) ever so slightly toward your nerve roots traveling through your spinal canal at this level. Stenosis just means a narrowing of the canal in which your spinal cord (or cauda equina at this level) travels.

Current research has suggested that a bulging disk does not cause pain by compressing nerves, but more likely by sensitizing nerves through local inflammation factors released by damaged cells and cells of the immune system (cytokines). Thus, over time as the inflammation goes down the pain will also go away. Usually, even after the pain is gone the disk bulge or herniation will remain, sometimes contacting nerves or even the spinal cord. It has been suggested that as many as 30% of the population has one or more asymptomatic (non-painful) disk bulges (references 1-3). It is likely a normal part of aging, so unless you are in severe pain don't panic :)

If you are in pain, try a visit to a chiropractor. Spinal manipulation and pain relieving stretches that a doctor of chiropractic can recommend will often relieve the pain associated with a disk bulge with very little risk (references 4-6).

Research is suggesting that unless there are severe neurological issues, surgery is not always good option unless (reference 7) everything else has been tried, and nothing else has worked. Similarly, research suggests that imaging such as MRI is not a great indicator of the need for surgery or severness of a herniation, as as many as 30% of the general public with no Back pain at all will have a "herniation" or disk bulge according to MRI (references 1-3). As such, it seems that sometimes what looks on MRI like a painful disk herniation may be a non-painful herniation and it is a different problem altogether that is actually causing the pain.

References

1) Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994;331:69 --73.

2) Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg1990;72:403-- 8.

3) Jarvik JJ, Hollingworth W, Heagerty P, Haynor DR, Deyo RA. The longitudinal assessment of Imaging and disability of the back (LAIDBack) Study: baseline data. Spine 2001;26:1158--66.

4) Oliphant D. Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment. J Manipulative Physiol Ther. 2004;27(3):197-210.

5) Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J 2006;6:131-137.

6) Liu J, Zhang S. Treatment of protrusion of lumbar intervertebral disc by pulling and turning manipulations. J Tradit Chin Med 2000;20:195-197.

7) Keller RB, Atlas SJ, Soule DN, Singer DE, Deyo RA. Relationship between rates and outcomes of operative treatment for lumbar disc herniation and spinal stenosis. J Bone Joint Surg 1999;81:752- 62.