Cervical Annular Concentric Tear

A cervical annular concentric tear is a type of injury to the intervertebral disc in the neck. The disc has a tough outer ring called the annulus fibrosus, made of concentric layers of collagen fibers. In a concentric tear, these layers split apart in a circular pattern around the disc’s core (nucleus pulposus), separating partially or completely NCBIRadiopaedia. When this occurs in one of the six cervical discs (C2–C7), it’s called a cervical annular concentric tear, which can sometimes progress to disc herniation if the inner gel pushes out through the tear Total Spine and Orthopedics.

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Anatomy of the Annulus Fibrosus in the Cervical Spine

Structure & Composition

• Composed of 10–20 concentric lamellae of fibrocartilage, alternating collagen fiber orientation at about 65° to the vertical axis Wheeless’ Textbook of OrthopaedicsWikipedia.

• The outer lamellae are rich in type I collagen, providing tensile strength; inner lamellae contain more type II collagen and proteoglycans for flexibility Wheeless’ Textbook of OrthopaedicsWikipedia.

Location

• Lies between cervical vertebrae C2–C7, forming a symphysis joint that allows head movement and absorbs shock Kenhub.

Origin & Insertion

• Fibers attach to the hyaline cartilage endplates of adjacent vertebral bodies, anchoring the disc above and below Wikipedia.

Blood Supply

• The outer one-third of the annulus receives small vessels from the vertebral and ascending cervical arteries; inner layers are avascular, relying on diffusion PhysiopediaWikipedia.

Nerve Supply

• Sinuvertebral nerves (recurrent meningeal branches of the spinal nerves) innervate the outer third, conveying pain when tears occur. Additional branches from the dorsal rami also contribute PhysiopediaRadiopaedia.

Functions

1. Containment: Holds the nucleus pulposus in place, preventing leakage.

2. Load Distribution: Spreads compressive forces evenly across the disc Spine-healthWikipedia.

3. Shock Absorption: Acts like a radial tire, absorbing impacts.

4. Flexibility: Permits controlled neck flexion, extension, rotation, and lateral bending.

5. Stability: Maintains disc height and vertebral spacing for spinal cord protection.

6. Joint Integrity: Forms part of the cervical symphysis, guiding smooth vertebral movement Spine-healthWikipedia.

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Types of Annular Tears

Clinically, annular tears are classified by their orientation in the disc Florida Surgery ConsultantsTotal Spine and Orthopedics:

• Concentric Tears
  Circular splits between lamellae in the outer annulus; often due to twisting or trauma.

• Radial Tears
  Cracks that begin at the nucleus pulposus and extend outward; commonly age-related.

• Peripheral (Rim) Tears
  Horizontal separations in the outermost fibers, usually from a sudden injury or bone spur.

By Location

• Cervical (C1–C7)

• Thoracic (T1–T12)

• Lumbar (L1–L5) Florida Surgery Consultants.

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Common Causes

1. Age-related degeneration (disc dehydration, brittleness)

2. Traumatic injury (e.g., whiplash in car accidents)

3. Repetitive neck motions (e.g., looking at screens)

4. Poor posture (forward head, “text neck”)

5. Heavy lifting with poor technique

6. Axial loading (compression forces on the spine)

7. Sports injuries (contact sports, wrestling)

8. Falls onto the head or shoulders

9. Sudden twisting movements

10. Obesity (increased spinal load)

11. Smoking (reduces disc nutrition)

12. Genetic predisposition (weaker collagen)

13. Poor nutrition (low proteoglycan production)

14. Dehydration (disc water loss)

15. Rheumatoid arthritis (inflammatory degeneration)

16. Osteoporosis (weakened vertebrae, abnormal stress)

17. Prior spinal surgery (scar-related stress)

18. Chronic inflammation (facet joint arthritis)

19. Spinal infections (discitis)

20. Spinal tumors (structural disruption) Total Spine and OrthopedicsFlorida Surgery Consultants.

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Common Symptoms

1. Neck pain (localized)

2. Stiffness (reduced range of motion)

3. Radiating arm pain (cervical radiculopathy)

4. Shoulder blade discomfort

5. Burning or hot sensation in neck/arm

6. Tingling or “pins and needles”

7. Numbness in fingers or hand

8. Muscle weakness in shoulder/arm

9. Headaches (occipital region)

10. Pain worsening with movement (flexion/extension)

11. Pain at night (disturbs sleep)

12. Muscle spasms in neck

13. Limited lateral bending

14. Pain when coughing or sneezing

15. Grinding or “crunching” sounds

16. Dizziness (in severe cases)

17. Balance issues (if spinal cord affected)

18. Fatigue from chronic discomfort

19. Reduced coordination of hand movements

20. Local tenderness on palpation Total Spine and OrthopedicsTotal Spine and Orthopedics.

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Diagnostic Tests

1. Physical examination (range of motion, palpation)

2. MRI (Magnetic Resonance Imaging) – gold standard for soft tissue and tear visualization Total Spine and OrthopedicsNCBI.

3. CT (Computed Tomography) – detailed bony structure and advanced disc tears.

4. X-ray – rules out fractures, alignment issues.

5. Provocative discography – injects dye to reproduce pain and outline tear Dr. Tony Mork.

6. Myelography – contrast study of spinal canal for nerve compression.

7. EMG (Electromyography) – assesses nerve root function.

8. Nerve conduction study – measures signal speed in peripheral nerves.

9. High-Intensity Zone (HIZ) sign on T2 MRI – indicates active annular fissure ResearchGate.

10. Flexion-extension X-rays – evaluates segmental instability.

11. SPECT bone scan – detects areas of increased bone metabolism.

12. Ultrasound (in research settings) – limited for disc imaging.

13. Digital infrared thermography – maps skin temperature changes.

14. Neurodynamic testing – tension tests for nerve root irritation.

15. Pressure algometry – measures pain threshold over disc.

16. Straight leg raise test (for lumbar but sometimes used in cervical context).

17. Spurling’s test – reproduces radicular pain by extending/rotating neck.

18. Jackson’s compression test – lateral flexion with axial load.

19. Vibratory sense testing – for sensory involvement.

20. Central motor conduction time (via evoked potentials) – assesses spinal cord involvement.

Most are used in combination to confirm diagnosis and plan treatment Total Spine and OrthopedicsDr. Tony Mork.

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Non-Pharmacological Treatments

1. Rest & activity modification (short-term)

2. Physical therapy (strengthening, stretching)

3. Neck isometric exercises

4. Posture training & ergonomic correction Total Spine and OrthopedicsBonati Spine Institute.

5. Heat therapy (moist heat packs)

6. Cold therapy (ice packs)

7. Cervical traction (mechanical or manual)

8. Massage therapy (myofascial release)

9. Chiropractic manipulation (in selected patients)

10. Acupuncture

11. Yoga (neck-safe poses)

12. Pilates (core stabilization)

13. Aquatic therapy (water buoyancy)

14. TENS (Transcutaneous Electrical Nerve Stimulation)

15. Ultrasound therapy (deep heating)

16. Low-level laser therapy

17. Biofeedback (muscle relaxation)

18. Mindfulness meditation (pain coping)

19. Tai Chi (gentle movement)

20. Ergonomic chair & pillow

21. Sleeping posture adjustment (supine with support)

22. Inversion therapy (gravity boots)

23. Hydrotherapy (warm pool exercises)

24. Intradiscal biacuplasty (radiofrequency energy, minimally invasive)

25. Percutaneous cervical nucleoplasty (radiofrequency coblation)

26. Cervical orthosis (soft collar, short-term)

27. Trigger point injections (dry needling)

28. Alexander Technique (movement re-education)

29. Feldenkrais Method (awareness through movement)

30. Correct lifting techniques (body mechanics training)

These approaches aim to relieve pain, improve function, and promote healing without drugs Total Spine and OrthopedicsBonati Spine Institute.

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Commonly Used Drugs

1. Ibuprofen (NSAID)

2. Naproxen (NSAID)

3. Diclofenac (NSAID)

4. Meloxicam (NSAID)

5. Celecoxib (COX-2 inhibitor)

6. Acetaminophen (analgesic)

7. Tramadol (opioid-like)

8. Codeine (opioid)

9. Cyclobenzaprine (muscle relaxant)

10. Tizanidine (muscle relaxant)

11. Carisoprodol (muscle relaxant)

12. Gabapentin (neuropathic pain agent) Wikipedia.

13. Pregabalin (neuropathic pain agent) Wikipedia.

14. Amitriptyline (TCA for nerve pain) PMC.

15. Duloxetine (SNRI for chronic pain)

16. Nortriptyline (TCA alternative)

17. Prednisone (oral corticosteroid)

18. Methylprednisolone (oral corticosteroid)

19. Dexamethasone (injectable corticosteroid)

20. Lidocaine patch (topical analgesic)

21. Capsaicin cream (topical)

Drug choice depends on pain type, severity, and patient factors NCBIUSA Spine Care.

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Surgical Treatments

1. Anterior Cervical Discectomy and Fusion (ACDF)

2. Cervical Artificial Disc Replacement

3. Posterior Cervical Discectomy (microdiscectomy)

4. Laminoplasty (unilateral/bilateral)

5. Laminectomy and Foraminotomy

6. Posterior Cervical Fusion (wiring or instrumentation)

7. Endoscopic Cervical Discectomy

8. Percutaneous Laser Disc Decompression

9. Cervical Corpectomy (removal of vertebral body)

10. Minimally Invasive Spine Surgery (keyhole approaches) Florida Surgery ConsultantsTotal Spine and Orthopedics.

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Prevention Strategies

1. Maintain good posture at desk and while standing

2. Ergonomic workstation setup (monitor at eye level)

3. Regular neck and upper back exercises

4. Core strengthening (stabilizes spine)

5. Lift with legs, not back

6. Avoid prolonged static positions – take breaks every 30 minutes

7. Use supportive pillows and mattress

8. Stay well-hydrated (disc hydration)

9. Maintain healthy weight

10. Quit smoking (improves disc nutrition) Total Spine and OrthopedicsTotal Spine and Orthopedics.

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When to See a Doctor

Seek medical attention if you experience:

• Severe, unremitting neck pain not relieved by rest or medication

• Progressive neurological deficits (weakness, numbness)

• Loss of bowel or bladder control (rare, emergency)

• Sudden, sharp pain after injury

• Fever or signs of infection with neck pain

• Pain that wakes you at night or persists > 6 weeks Total Spine and Orthopedics.

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FAQs

1. What exactly causes a concentric tear?
   Concentric tears form when the collagen layers in the disc’s outer ring split apart in a circular path. This often happens from twisting injuries or sudden torsion on the neck, but can also result from weakened disc fibers due to aging and repeated stress Total Spine and OrthopedicsTotal Spine and Orthopedics.

2. Can a concentric tear heal by itself?
   Many concentric tears are asymptomatic and may heal slowly over 12–24 months as new collagen forms. Conservative treatments help control symptoms while the body repairs the tear Deuk SpineTotal Spine and Orthopedics.

3. How long until I feel better?
   Symptom improvement often begins within weeks of rest, physical therapy, and medications, but complete healing of the annulus may take 18–24 months Deuk Spine.

4. Is surgery always required?
   No. Over 90% of patients improve with non-surgical care. Surgery is reserved for those with persistent pain or neurological deficits unresponsive after 6–12 weeks Florida Surgery ConsultantsDeuk Spine.

5. What role does physical therapy play?
   Physical therapy strengthens neck muscles, improves posture, and enhances disc nutrition through movement. It is a cornerstone of non-surgical management Total Spine and OrthopedicsBonati Spine Institute.

6. Are steroid injections helpful?
   Epidural steroid injections or facet joint injections can reduce inflammation and pain around the tear, providing relief for several months in some patients NCBITotal Spine and Orthopedics.

7. What imaging shows a concentric tear?
   MRI with T2 sequences reveals high-intensity zones (HIZ) in the annulus, indicating fluid in the tear. Discography can confirm pain reproduction and dye leakage along the tear path ResearchGateDr. Tony Mork.

8. Can it cause permanent damage?
   Most concentric tears do not lead to permanent deficits if treated appropriately. Rarely, a large tear can progress to disc herniation compressing nerves or spinal cord, requiring surgery RadiopaediaTotal Spine and Orthopedics.

9. Are there any at-home exercises I should avoid?
   Avoid neck hyper-extension, aggressive twists, and heavy head-supported rowing. Gentle isometric holds and chin tucks are safer Total Spine and Orthopedics.

10. Does smoking make it worse?
    Yes. Smoking reduces blood flow to the outer annulus, slowing healing and accelerating degeneration Total Spine and Orthopedics.

11. Can I use over-the-counter painkillers?
    NSAIDs like ibuprofen or naproxen and acetaminophen can help manage pain and inflammation in the short term USA Spine Care.

12. What about nerve pain medications?
    Drugs such as gabapentin and pregabalin target nerve-related pain and can be effective if radicular symptoms develop WikipediaWikipedia.

13. Will my tear cause other disc problems?
    If untreated and under ongoing stress, a concentric tear can progress to a radial tear or disc herniation, potentially leading to more severe nerve compression Total Spine and Orthopedics.

14. How do I prevent it from happening again?
    Maintain proper posture, do regular neck-strengthening exercises, use ergonomic supports, and avoid sudden twisting motions Total Spine and OrthopedicsTotal Spine and Orthopedics.

15. When should I follow up with my doctor?
    If pain persists beyond 6–8 weeks of conservative care, if new weakness or numbness appears, or if you have severe red-flag symptoms (e.g., bowel/bladder changes), see your physician promptly Total Spine and Orthopedics.

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Last Updated: May 03, 2025.