Annular Tears: Causes, Symptoms, and Treatment
Medically reviewed by Sumiran Racherla, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Annular Tears?
Annular tears are usually treated first by a primary care doctor or a physical therapist, a health professional who treats movement and muscle problems. For pain that does not improve, patients see an orthopedic spine surgeon or a neurosurgeon, doctors who operate on the spine. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What are annular tears?
An annular tear, also called an annular fissure, is a crack in one or more layers of the annulus fibrosus. That is the tough, fibrous outer ring of a spinal disc. Each disc sits between two bones of the spine and has a soft, gel-like center covered by this outer ring.
Most annular fissures cause no symptoms at all. Doctors often find them by chance on scans done for other reasons. In adults, estimates range from a few percent to more than 50 percent, depending on the criteria and imaging used. Some tears do hurt, and a tear can let the soft center push out and press on nearby nerves.
Symptoms
When a tear does cause symptoms, it may cause one of two patterns. Some people feel deep, local pain in the back that gets worse with movements that stress the tear. Others have radicular symptoms, meaning the passing nerve root gets irritated. That can cause pain, tingling, or weakness along the path of the nerve, such as down a leg. If disc material herniates, meaning it pushes out of the disc, it can compress nerve roots or the spinal cord.
Causes and who gets it
Tears most often happen at the back or back-side part of the disc ring, where its fibers are arranged in a way that makes it weaker. Disc degeneration plays a large part. As discs age, they lose water and their ring gets stiffer, so it takes more strain. Tears are common in the low back, which bears heavy loads, and they peak in middle age. Disc degeneration shows up on scans in 37 percent of people without symptoms by age 20 and 96 percent by age 80, so many findings are part of normal aging.
How doctors diagnose it
Doctors start with a history and a neurological exam, meaning a check of nerve function like strength, feeling, and reflexes. MRI is the main imaging test for discs. On MRI, a tear often shows as a bright spot in the dark outer ring. If a disc has herniated, the ring must be torn, even when the tear itself is not seen. A plain CT scan is less sensitive because it cannot show the swelling of a torn ring. Discography, a test that injects dye into a disc to provoke pain, is done only in special cases because it can damage the disc.
Treatment
A tear found by chance on a scan needs no treatment. Many tears calm down over time, and there is no proof that treating a tear that causes no symptoms helps.
For a painful tear without disc herniation, the mainstay of treatment is non-steroidal anti-inflammatory medicines (NSAIDs, such as ibuprofen) plus low-impact physical therapy. The therapy may help strengthen the core muscles that support the spine. Some patients get steroid injections near the nerve to ease symptoms faster.
If symptoms fail to improve or get worse, surgery may be considered. Choices include laminotomy, laminectomy, foraminotomy, discectomy, or fusion. A discectomy removes part of a herniated disc. Most low back pain, even with disc problems, does well with conservative care.
When to see a doctor
Call your doctor if back pain does not get better within a few weeks, or if it comes with fever, chills, or unexpected weight loss. Call 911 or go to the emergency room right away for red flag signs: weakness in your legs, or loss of bladder and bowel control. These can mean serious nerve pressure. One possible complication of a disc bulge is cauda equina syndrome, an emergency that needs care right away.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either can examine you, order imaging, and guide conservative care. They can refer you to a spine specialist if your pain lasts.
Common questions
Do all annular tears need treatment?
No. Most annular fissures are asymptomatic, and tears are often found in people who feel fine. A tear found on a scan without symptoms needs no treatment.
Can an annular tear heal?
Sometimes. Discs have a limited ability to heal. Some tears without symptoms may resolve over time. Care focuses on easing pain and strengthening the muscles that support the spine.
Can a tear lead to a herniated disc?
Yes. A tear can let the soft center of the disc push through the outer ring. That is called disc herniation, and the herniated material can press on nearby nerves. In that case, treatment is aimed at the herniation itself.
Will I need surgery?
Most people do not. The mainstay of treatment is anti-inflammatory medicines and physical therapy. Surgery is considered only when symptoms fail to improve or get worse despite other treatment.
Sources
- StatPearls, NCBI Bookshelf - Annular Disc Tear
- StatPearls, NCBI Bookshelf - Lumbosacral Discogenic Syndrome
- OrthoInfo, American Academy of Orthopaedic Surgeons - Low Back Pain
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
