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Prevalance of asymptomatic annular tears and disk herniations

PainSci » bibliography » Stadnik et al 1998
Tags: back pain, neurology, sciatica, intervertebral disc, radiculopathy, spine, leg, pain problems, butt, hip, herniation, limbs, rapdy

Three articles on PainSci cite Stadnik 1998: 1. The Complete Guide to Trigger Points & Myofascial Pain2. The Complete Guide to Low Back Pain3. Your Back Is Not Out of Alignment

PainSci notes on Stadnik 1998:

29 of 36 asymptomatic people nevertheless had “bulging disk and focal disk protrusion.” From the abstract: “Annular tears and focal disk protrusions on MR images ... are frequently found in an asymptomatic population.” Indeed, these researchers found that a whopping 81% of pain-free adults had bulging disks, and 56% had annular tears (ripping of connective tissue near the disk).

While that is interesting, it is also worth noting that these signs are at the milder end of the spectrum of pathological possibilities for discs, and therefore it is less surprising that they would be asymptomatic.

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

PURPOSE: To evaluate the prevalence and radiologic findings of annular tear (especially of contrast material enhancement), bulging disk, and disk herniation on T2-weighted and gadolinium-enhanced T1-weighted magnetic resonance (MR) images in people without low back pain (LBP) or sciatica.

MATERIALS AND METHODS: Thirty-six volunteers without LBP and/or sciatica (18 with no symptoms in their lifetime and 18 who were pain free for at least 6 months) were examined with sagittal and axial T2-weighted fast spin-echo (SE) and sagittal gadolinium-enhanced T1- weighted fast SE imaging. The prevalence and MR findings of bulging disk, focal protrusion, extrusion, and nonenhancing or enhancing annular tears were assessed.

RESULTS: The prevalence of bulging disk and focal disk protrusion was 81% (29 volunteers) and 33% (12 volunteers), respectively. There were no extrusions. Twenty-eight annular tears were found in 20 patients (56%); 27 tears (96%) also showed contrast enhancement.

CONCLUSION: Annular tears and focal disk protrusions on MR images, with or without contrast enhancement, are frequently found in an asymptomatic population. Extruded disk herniation, displacement of nerve root, and interruption of annuloligamentous complex are unusual findings in an asymptomatic population and can be more closely related to patients with LBP or sciatica.

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