Posterior Cervical Annular Tear

Dr. Lisa S. Apfel MD - Spine and Neurosurgery Dr. Lisa S. Apfel MD - Spine and Neurosurgery
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Degenerative Bones, Joints, and Spine Care (A - Z)

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

  1. Shock Absorption: Distributes compressive loads via the nucleus pulposus.

  2. Stability: Restrains excessive vertebral motion, acting like a ligament.

  3. Load Sharing: Evenly spreads axial forces across vertebral bodies.

  4. Flexibility: Allows slight movement between vertebrae.

  5. Tensile Resistance: Lamellar fiber orientation resists torsional and shear stress.

  6. Attachment Site: Serves as anchor for the posterior longitudinal ligament, reinforcing the canal’s posterior wall Wikipedia.

Types of Annular Tears

  1. 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.

  2. 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

  1. Degenerative Disc Disease (DDD) – age-related disc breakdown Advanced Spine Center

  2. Bone Spurs – osteophytes injure annulus Advanced Spine Center

  3. Traumatic Injuries – sports collisions, car accidents, falls Advanced Spine Center

  4. Overuse/Repetitive Strain – heavy lifting, manual labor Advanced Spine Center

  5. Genetic Collagen Disorders – poor annular fiber quality Advanced Spine Center

  6. Age-Related Wear & Tear – general degeneration/dehydration

  7. Obesity – increased axial load Dr. Tony Mork

  8. Smoking – reduced disc nutrition, impaired healing Florida Surgery Consultants

  9. Poor Posture – chronic cervical flexion/extension stress Florida Surgery Consultants

  10. Ergonomic Strain – prolonged desk work, dual screens Centeno Schultz

  11. High-Impact Sports – football, rugby, gymnastics BEST Health System

  12. Whiplash Injury – sudden hyperextension/hyperflexion VSI® (Virginia Spine Institute)

  13. Repeated Axial Loading – running, jumping Orthopedic Reviews

  14. Metabolic Disorders – diabetes, glycation end-products PMC

  15. Inflammatory Conditions – IL-1 and MMP-3 mediated matrix degradation PMC

  16. Genetic Polymorphisms – COL9A2 Trp2 allele risk PMC

  17. Endplate Damage – microfractures impair disc integrity Wheeless’ Textbook of Orthopaedics

  18. Spinal Infections – discitis weakening annulus Wheeless’ Textbook of Orthopaedics

  19. Tumors – rare destructive lesions Wheeless’ Textbook of Orthopaedics

  20. Post-Surgical Changes – re-tear after discectomy Wheeless’ Textbook of Orthopaedics

Symptoms

  1. Neck pain (axial) Advanced Spine Center

  2. Pain radiating to shoulder blades Advanced Spine Center

  3. Radicular arm pain (C5–T1 distribution) Advanced Spine Center

  4. Paresthesia (tingling) in hands Advanced Spine Center

  5. Numbness in fingers Advanced Spine Center

  6. Muscle weakness in arms Advanced Spine Center

  7. Reduced neck range of motion Integrity Spine & Orthopedics

  8. Cervicogenic headache Verywell Health

  9. Stiffness, muscle spasm Integrity Spine & Orthopedics

  10. Fatigue in neck muscles VSI® (Virginia Spine Institute)

  11. Dizziness, lightheadedness Verywell Health

  12. Scapular ache Integrity Spine & Orthopedics

  13. Lhermitte’s sign (“electric shocks” down spine) PMC

  14. Hyperreflexia (if myelopathy) PMC

  15. Hoffmann’s sign PMC

  16. Gait disturbance (severe myelopathy) PMC

  17. Bowel/bladder dysfunction (rare) PMC

  18. Sleep disturbances due to pain VSI® (Virginia Spine Institute)

  19. Tenderness on palpation Integrity Spine & Orthopedics

  20. Pain worsened by coughing/sneezing Dr. Tony Mork

Diagnostic Tests

  1. MRI (T2-weighted) – detects HIZs in posterior annulus Radiopaedia

  2. MRI with contrast – highlights enhancing fissures (EAF) American Journal of Neuroradiology

  3. CT scan – detailed bone and calcification views Radiologyinfo.org

  4. CT discogram (CT discography) – visualizes contrast leak in annulus Dr. Tony Mork

  5. Provocative discography – reproduces pain and shows tear on fluoroscopy ChiroGeek

  6. X-ray (dynamic flexion-extension) – assess instability uk.scan.com

  7. CT myelography – for patients who cannot have MRI Radiologyinfo.org

  8. EMG (electromyography) – evaluates nerve root involvement uk.scan.com

  9. Nerve conduction study – quantifies radiculopathy severity uk.scan.com

  10. Somatosensory evoked potentials – assess spinal cord conduction PMC

  11. Bone scan – rule out infection/tumor Wheeless’ Textbook of Orthopaedics

  12. Blood tests (ESR/CRP) – screen for infection/inflammation Wheeless’ Textbook of Orthopaedics

  13. Ultrasound – guided injections, soft-tissue evaluation Radiologyinfo.org

  14. Provocative Spurling’s test – clinical radiculopathy sign Verywell Health

  15. Lhermitte’s maneuver – myelopathy indicator PMC

  16. Hoffmann’s test – upper motor neuron sign PMC

  17. Reflex testing (biceps, triceps, brachioradialis) – neurological deficit Verywell Health

  18. Sensory examination – mapping dermatomal deficits Verywell Health

  19. Motor strength grading – quantify weakness Verywell Health

  20. Gait and balance assessment – detect myelopathy Verywell Health

Non-Pharmacological Treatments

  1. Physical therapy – stretching/strengthening Advanced Spine Center

  2. Cervical stabilization exercises Advanced Spine Center

  3. Manual therapy/chiropractic adjustments Advanced Spine Center

  4. Cervical traction (mechanical) Advanced Spine Center

  5. Posture correction/ergonomics Advanced Spine Center

  6. Heat therapy (moist heat packs)

  7. Cold therapy (ice packs)

  8. TENS (transcutaneous electrical nerve stimulation)

  9. Ultrasound therapy Radiologyinfo.org

  10. Laser therapy (low-level)

  11. Acupuncture Verywell Health

  12. Massage therapy Verywell Health

  13. Yoga – cervical mobility Verywell Health

  14. Pilates – core support Verywell Health

  15. Aquatic therapy Verywell Health

  16. Biofeedback – pain modulation Verywell Health

  17. Mindfulness meditation Verywell Health

  18. Ergonomic adjustments at work Florida Surgery Consultants

  19. Lifestyle modification (weight loss) Dr. Tony Mork

  20. Smoking cessation Florida Surgery Consultants

  21. Nutritional support (vitamins C, D) PMC

  22. Hydration – maintain disc turgor

  23. Core strengthening Verywell Health

  24. Cervical collar (short-term) uk.scan.com

  25. Spinal decompression tables uk.scan.com

  26. Postural taping/support Verywell Health

  27. Ergonomic pillow/bed support Verywell Health

  28. Avoidance of aggravating activities Verywell Health

  29. Quitting alcohol (nutrient compromise) Wheeless’ Textbook of Orthopaedics

  30. Regular low-impact exercise (walking) Verywell Health

Pharmacological Treatments

  1. NSAIDs (ibuprofen, naproxen) Advanced Spine Center

  2. Acetaminophen Advanced Spine Center

  3. Muscle relaxants (cyclobenzaprine) Advanced Spine Center

  4. Oral corticosteroids (prednisone taper) Advanced Spine Center

  5. Epidural steroid injections Advanced Spine Center

  6. Gabapentin Advanced Spine Center

  7. Pregabalin Advanced Spine Center

  8. Amitriptyline Advanced Spine Center

  9. Duloxetine Advanced Spine Center

  10. Tramadol Advanced Spine Center

  11. Opioids (short-term, e.g., oxycodone) Advanced Spine Center

  12. Topical NSAIDs (diclofenac gel) Advanced Spine Center

  13. Lidocaine patch Advanced Spine Center

  14. Capsaicin cream Advanced Spine Center

  15. Calcitonin (off-label) PMC

  16. Bisphosphonates (if osteoporosis-related) Wheeless’ Textbook of Orthopaedics

  17. Vitamin D supplementation PMC

  18. Calcium PMC

  19. Platelet-rich plasma (PRP) injections Verywell Health

  20. Prolotherapy (dextrose injections) Wheeless’ Textbook of Orthopaedics

Surgical Options

  1. Anterior Cervical Discectomy & Fusion (ACDF) Florida Surgery Consultants

  2. Cervical Disc Replacement Florida Surgery Consultants

  3. Posterior Cervical Foraminotomy Florida Surgery Consultants

  4. Laminectomy Florida Surgery Consultants

  5. Laminoplasty Florida Surgery Consultants

  6. Posterior Partial Facetectomy Florida Surgery Consultants

  7. Minimally Invasive Microdiscectomy Florida Surgery Consultants

  8. Endoscopic Annuloplasty Wheeless’ Textbook of Orthopaedics

  9. Spinal Cord Stimulator Implant (for refractory pain) Wheeless’ Textbook of Orthopaedics

  10. Posterior Fusion (wiring/rods) Wheeless’ Textbook of Orthopaedics

Prevention Strategies

  1. Proper lifting techniques Florida Surgery Consultants

  2. Regular exercise (neck and core) Verywell Health

  3. Ergonomic workstation Florida Surgery Consultants

  4. Good posture (especially sitting)

  5. Weight management Dr. Tony Mork

  6. Smoking cessation Florida Surgery Consultants

  7. Adequate hydration

  8. Balanced diet rich in collagen precursors PMC

  9. Frequent breaks from static positions

  10. Early treatment of minor neck pain Dr. Tony Mork

When to See a Doctor

Frequently Asked Questions

  1. 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.

  2. 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.

  3. 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.

  4. Is MRI always diagnostic?
    MRI is best first test but can miss subtle tears; discography may be needed ChiroGeek.

  5. What is a “high-intensity zone” (HIZ)?
    A bright T2 signal in the annulus indicating fluid/granulation tissue in a tear Radiopaedia.

  6. Are all tears painful?
    No—most are asymptomatic; “toxic” tears (with inflammation) cause pain Dr. Tony Mork.

  7. What lifestyle changes help?
    Ergonomics, exercise, posture, weight loss, and smoking cessation Florida Surgery Consultants.

  8. When is surgery indicated?
    Severe radiculopathy, myelopathy, or failed conservative management after 6–12 weeks Florida Surgery Consultants.

  9. What are the risks of discectomy?
    Adjacent-segment degeneration, infection, nonunion in fusions Wikipedia.

  10. Can physical therapy worsen a tear?
    If done improperly; should be guided by a trained therapist .

  11. Do injections help?
    Epidural steroids and PRP can reduce inflammation but may not heal tear Advanced Spine Center.

  12. Is there a risk of spinal instability?
    Large tears or extensive decompression can destabilize segments American Journal of Neuroradiology.

  13. Are there regenerative treatments?
    Experimental: stem cell therapy, PRP, gene therapy PMC.

  14. What is the prognosis?
    Many improve with conservative care; chronic cases may need surgery Verywell Health.

  15. How can I prevent recurrence?
    Maintain neck strength, flexibility, and ergonomics; avoid high-risk activities Florida Surgery Consultants.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: May 03, 2025.

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References

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