A posterior cervical annular tear is a disruption or fissure in the outer rings (annulus fibrosus) of a cervical intervertebral disc, most often in the back (posterior) portion of the disc. On T2-weighted MRI, these tears frequently appear as a “high-intensity zone” (HIZ) within the normally dark annular fibers, indicating fluid or granulation tissue in the fissure RadiopaediaRadiopaedia. Such tears can be a source of neck pain, radicular arm pain, and, in severe cases, myelopathic signs.
Anatomy of the Cervical Annulus Fibrosus
The annulus fibrosus is the tough outer ring of the intervertebral disc, composed of concentric layers (lamellae) of fibrocartilage that surround the softer nucleus pulposus Wikipedia.
Location: Between adjacent cervical vertebral bodies (C2–3 through C7–T1).
Structure & Composition: 15–25 concentric lamellae of type I (outer) and type II (inner) collagen fibers, arranged at alternating angles of ~65° to the vertical axis Wheeless’ Textbook of OrthopaedicsWikipedia.
Origin/Insertion: Outer lamellae attach to the ring apophyses of the vertebral endplates; inner lamellae blend with the nucleus pulposus.
Blood Supply: Limited to the outer third via small vessels from the adjacent vertebral endplates and segmental arteries; inner portions are avascular and rely on diffusion Physiopedia.
Nerve Supply: Pain fibers in the outer third are carried by the sinuvertebral (meningeal) nerves, branches of the spinal nerves (recurrent meningeal branches) Wikipedia.
Key Functions
Shock Absorption: Distributes compressive loads via the nucleus pulposus.
Stability: Restrains excessive vertebral motion, acting like a ligament.
Load Sharing: Evenly spreads axial forces across vertebral bodies.
Flexibility: Allows slight movement between vertebrae.
Tensile Resistance: Lamellar fiber orientation resists torsional and shear stress.
Attachment Site: Serves as anchor for the posterior longitudinal ligament, reinforcing the canal’s posterior wall Wikipedia.
Types of Annular Tears
Morphological Classification (StatPearls):
Concentric Tears: Lamellae separate in a circular pattern, parallel to endplates.
Radial Tears: Fissures from the nucleus outward through lamellae.
Peripheral (Transverse/Rim) Tears: Tears at the disc periphery, often near Sharpey’s fibers NCBI.
Imaging-Based HIZ Classification (Wakayama Spine Study):
Shape: Round, fissure, vertical, rim, enlarged.
Location: Posterior versus anterior annulus.
Signal Types: T1-low/T2-high, T1-iso/T2-high, T1-high/T2-high PMC.
Causes
Degenerative Disc Disease (DDD) – age-related disc breakdown Advanced Spine Center
Bone Spurs – osteophytes injure annulus Advanced Spine Center
Traumatic Injuries – sports collisions, car accidents, falls Advanced Spine Center
Overuse/Repetitive Strain – heavy lifting, manual labor Advanced Spine Center
Genetic Collagen Disorders – poor annular fiber quality Advanced Spine Center
Age-Related Wear & Tear – general degeneration/dehydration
Obesity – increased axial load Dr. Tony Mork
Smoking – reduced disc nutrition, impaired healing Florida Surgery Consultants
Poor Posture – chronic cervical flexion/extension stress Florida Surgery Consultants
Ergonomic Strain – prolonged desk work, dual screens Centeno Schultz
High-Impact Sports – football, rugby, gymnastics BEST Health System
Whiplash Injury – sudden hyperextension/hyperflexion VSI® (Virginia Spine Institute)
Repeated Axial Loading – running, jumping Orthopedic Reviews
Metabolic Disorders – diabetes, glycation end-products PMC
Inflammatory Conditions – IL-1 and MMP-3 mediated matrix degradation PMC
Genetic Polymorphisms – COL9A2 Trp2 allele risk PMC
Endplate Damage – microfractures impair disc integrity Wheeless’ Textbook of Orthopaedics
Spinal Infections – discitis weakening annulus Wheeless’ Textbook of Orthopaedics
Tumors – rare destructive lesions Wheeless’ Textbook of Orthopaedics
Post-Surgical Changes – re-tear after discectomy Wheeless’ Textbook of Orthopaedics
Symptoms
Neck pain (axial) Advanced Spine Center
Pain radiating to shoulder blades Advanced Spine Center
Radicular arm pain (C5–T1 distribution) Advanced Spine Center
Paresthesia (tingling) in hands Advanced Spine Center
Numbness in fingers Advanced Spine Center
Muscle weakness in arms Advanced Spine Center
Reduced neck range of motion Integrity Spine & Orthopedics
Cervicogenic headache Verywell Health
Stiffness, muscle spasm Integrity Spine & Orthopedics
Fatigue in neck muscles VSI® (Virginia Spine Institute)
Dizziness, lightheadedness Verywell Health
Scapular ache Integrity Spine & Orthopedics
Lhermitte’s sign (“electric shocks” down spine) PMC
Hyperreflexia (if myelopathy) PMC
Hoffmann’s sign PMC
Gait disturbance (severe myelopathy) PMC
Bowel/bladder dysfunction (rare) PMC
Sleep disturbances due to pain VSI® (Virginia Spine Institute)
Tenderness on palpation Integrity Spine & Orthopedics
Pain worsened by coughing/sneezing Dr. Tony Mork
Diagnostic Tests
MRI (T2-weighted) – detects HIZs in posterior annulus Radiopaedia
MRI with contrast – highlights enhancing fissures (EAF) American Journal of Neuroradiology
CT scan – detailed bone and calcification views Radiologyinfo.org
CT discogram (CT discography) – visualizes contrast leak in annulus Dr. Tony Mork
Provocative discography – reproduces pain and shows tear on fluoroscopy ChiroGeek
X-ray (dynamic flexion-extension) – assess instability uk.scan.com
CT myelography – for patients who cannot have MRI Radiologyinfo.org
EMG (electromyography) – evaluates nerve root involvement uk.scan.com
Nerve conduction study – quantifies radiculopathy severity uk.scan.com
Somatosensory evoked potentials – assess spinal cord conduction PMC
Bone scan – rule out infection/tumor Wheeless’ Textbook of Orthopaedics
Blood tests (ESR/CRP) – screen for infection/inflammation Wheeless’ Textbook of Orthopaedics
Ultrasound – guided injections, soft-tissue evaluation Radiologyinfo.org
Provocative Spurling’s test – clinical radiculopathy sign Verywell Health
Lhermitte’s maneuver – myelopathy indicator PMC
Hoffmann’s test – upper motor neuron sign PMC
Reflex testing (biceps, triceps, brachioradialis) – neurological deficit Verywell Health
Sensory examination – mapping dermatomal deficits Verywell Health
Motor strength grading – quantify weakness Verywell Health
Gait and balance assessment – detect myelopathy Verywell Health
Non-Pharmacological Treatments
Physical therapy – stretching/strengthening Advanced Spine Center
Cervical stabilization exercises Advanced Spine Center
Manual therapy/chiropractic adjustments Advanced Spine Center
Cervical traction (mechanical) Advanced Spine Center
Posture correction/ergonomics Advanced Spine Center
Heat therapy (moist heat packs)
Cold therapy (ice packs)
TENS (transcutaneous electrical nerve stimulation)
Ultrasound therapy Radiologyinfo.org
Laser therapy (low-level)
Acupuncture Verywell Health
Massage therapy Verywell Health
Yoga – cervical mobility Verywell Health
Pilates – core support Verywell Health
Aquatic therapy Verywell Health
Biofeedback – pain modulation Verywell Health
Mindfulness meditation Verywell Health
Ergonomic adjustments at work Florida Surgery Consultants
Lifestyle modification (weight loss) Dr. Tony Mork
Smoking cessation Florida Surgery Consultants
Nutritional support (vitamins C, D) PMC
Hydration – maintain disc turgor
Core strengthening Verywell Health
Cervical collar (short-term) uk.scan.com
Spinal decompression tables uk.scan.com
Postural taping/support Verywell Health
Ergonomic pillow/bed support Verywell Health
Avoidance of aggravating activities Verywell Health
Quitting alcohol (nutrient compromise) Wheeless’ Textbook of Orthopaedics
Regular low-impact exercise (walking) Verywell Health
Pharmacological Treatments
NSAIDs (ibuprofen, naproxen) Advanced Spine Center
Acetaminophen Advanced Spine Center
Muscle relaxants (cyclobenzaprine) Advanced Spine Center
Oral corticosteroids (prednisone taper) Advanced Spine Center
Epidural steroid injections Advanced Spine Center
Gabapentin Advanced Spine Center
Pregabalin Advanced Spine Center
Amitriptyline Advanced Spine Center
Duloxetine Advanced Spine Center
Tramadol Advanced Spine Center
Opioids (short-term, e.g., oxycodone) Advanced Spine Center
Topical NSAIDs (diclofenac gel) Advanced Spine Center
Lidocaine patch Advanced Spine Center
Capsaicin cream Advanced Spine Center
Calcitonin (off-label) PMC
Bisphosphonates (if osteoporosis-related) Wheeless’ Textbook of Orthopaedics
Vitamin D supplementation PMC
Calcium PMC
Platelet-rich plasma (PRP) injections Verywell Health
Prolotherapy (dextrose injections) Wheeless’ Textbook of Orthopaedics
Surgical Options
Anterior Cervical Discectomy & Fusion (ACDF) Florida Surgery Consultants
Cervical Disc Replacement Florida Surgery Consultants
Posterior Cervical Foraminotomy Florida Surgery Consultants
Laminectomy Florida Surgery Consultants
Laminoplasty Florida Surgery Consultants
Posterior Partial Facetectomy Florida Surgery Consultants
Minimally Invasive Microdiscectomy Florida Surgery Consultants
Endoscopic Annuloplasty Wheeless’ Textbook of Orthopaedics
Spinal Cord Stimulator Implant (for refractory pain) Wheeless’ Textbook of Orthopaedics
Posterior Fusion (wiring/rods) Wheeless’ Textbook of Orthopaedics
Prevention Strategies
Proper lifting techniques Florida Surgery Consultants
Regular exercise (neck and core) Verywell Health
Ergonomic workstation Florida Surgery Consultants
Good posture (especially sitting)
Weight management Dr. Tony Mork
Smoking cessation Florida Surgery Consultants
Adequate hydration
Balanced diet rich in collagen precursors PMC
Frequent breaks from static positions
Early treatment of minor neck pain Dr. Tony Mork
When to See a Doctor
Pain persisting >6 weeks despite conservative care Dr. Tony Mork
Progressive neurological deficits (weakness, numbness) Integrity Spine & Orthopedics
Signs of myelopathy (gait disturbance, bladder dysfunction) PMC
Severe trauma or suspected fracture Wheeless’ Textbook of Orthopaedics
Fever, chills, or concern for infection Wheeless’ Textbook of Orthopaedics
Unexplained weight loss or night pain Wheeless’ Textbook of Orthopaedics
Frequently Asked Questions
What exactly is a posterior cervical annular tear?
A tear in the back part of the disc’s annular fibers, often seen as a bright spot on T2 MRI Radiopaedia.How does it differ from a herniated disc?
In annular tears, the nucleus is contained; herniation means it has extruded through the annulus uk.scan.com.Can an annular tear heal on its own?
Outer-annulus tears may heal due to blood supply; inner ones often remain chronic uk.scan.com.Is MRI always diagnostic?
MRI is best first test but can miss subtle tears; discography may be needed ChiroGeek.What is a “high-intensity zone” (HIZ)?
A bright T2 signal in the annulus indicating fluid/granulation tissue in a tear Radiopaedia.Are all tears painful?
No—most are asymptomatic; “toxic” tears (with inflammation) cause pain Dr. Tony Mork.What lifestyle changes help?
Ergonomics, exercise, posture, weight loss, and smoking cessation Florida Surgery Consultants.When is surgery indicated?
Severe radiculopathy, myelopathy, or failed conservative management after 6–12 weeks Florida Surgery Consultants.What are the risks of discectomy?
Adjacent-segment degeneration, infection, nonunion in fusions Wikipedia.Can physical therapy worsen a tear?
If done improperly; should be guided by a trained therapist .Do injections help?
Epidural steroids and PRP can reduce inflammation but may not heal tear Advanced Spine Center.Is there a risk of spinal instability?
Large tears or extensive decompression can destabilize segments American Journal of Neuroradiology.Are there regenerative treatments?
Experimental: stem cell therapy, PRP, gene therapy PMC.What is the prognosis?
Many improve with conservative care; chronic cases may need surgery Verywell Health.How can I prevent recurrence?
Maintain neck strength, flexibility, and ergonomics; avoid high-risk activities Florida Surgery Consultants.
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The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members
Last Updated: May 03, 2025.
