Annular fissure

Case contributed by Dr Olumuyiwa Ifedayo Ajayi

Presentation

Recurrent low back pain.

Patient Data

Age: 50 years
Gender: Male
MRI

An area of high T2 signal intensity is seen deep to the annulus fibrosus centrally on the axial image at L5-S1 disc.

Case Discussion

The structural integrity of the posterior annulus fibrosus is compromised by repetitive microtrauma which will eventually lead to formation of fissures in the annulus fibrosus. This can be seen as an area of increased signal intensity on T2 weighted MRI imaging. The presence of the a high intensity zone is believed to be related to discogenic pain as it involves the outer, highly innervated layers of the annulus. Most patients are however asymptomatic while fissures close to the dorsal root ganglion are known to be most painful.

 

 

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