It is more common to develop an annular tear in the lumbar spine than at any other level of the vertebral column. That’s because the lumbar (lower back) region is under almost constant strain from supporting most of the body’s weight while also being subjected to a wide range of stress-inducing movement. An annular tear, or rupture in the fibrous outer wall of an intervertebral disc, can occur because of traumatic injury, or gradually, as part of the body’s natural aging process. Tears in the outer wall of a disc are not symptomatic, but when the gel-like nucleus material of a disc leaks through a tear, adjacent nerve roots or the spinal cord becomes vulnerable. Irritation of these delicate components of the body’s nervous system can produce localized pain, radiating pain, tingling, numbness and muscle weakness.
Nerve compression location determines symptomatic areas
Should an annular tear in the lumbar region result in the extrusion of inner disc material, there is a chance that the sciatic nerve will be affected. Irritation or compression of the sciatic nerve – the longest and widest nerve in the body – produces the set of symptoms known as sciatica. Regardless of whether the sciatic nerve is affected, the area of the body that experiences symptoms will depend on which vertebral level is the site of the nerve compression. Because nerve roots occur in pairs and are located between the vertebrae, nerve root compression is usually annotated by the identities of the nearest two vertebrae. For example, the 12th thoracic vertebra is annotated T12, the first lumbar vertebra is annotated L1 and so on. The symptoms, then, will be experienced in the location of the body innervated by the particular nerve, as described below:
- T12 to L1 – Pain in the medial thigh
- L1 to L2 – Pain in the anterior upper thigh, slight quadriceps weakness
- L2 to L3 – Anterolateral thigh pain, quadriceps weakness, diminished patellar reflex
- L3 to L4 – Posterolateral thigh pain, anterior lower leg pain, quadriceps weakness, reduction of patellar reflex
- L4 to L5 – Foot pain, weakness of the foot and big toe extensor
- L5 to S1 – Pain on the outside of the foot, reduced Achilles tendon reflex
Treating an annular tear in the lumbar spine
In most cases, symptoms associated with an annular tear in the lumbar spine can be managed using pain medication, exercise, corticosteroid injections and other conservative treatment methods. Surgery might become an option if conservative treatment fails to bring relief after several weeks or months. If you are interested in learning about an effective alternative to traditional open back surgery, contact Laser Spine Institute for information about our minimally invasive, outpatient procedures.