An annular fissure and an annular tear are the same finding: a separation in the tough outer fibers of a disc, called the annulus. Radiologists now prefer the word fissure because "tear" sounded like it meant trauma. The finding is common in people without pain, and on its own it was not linked to back pain in the best available meta-analysis. That matters in car accident cases, where "annular tear" on an MRI is sometimes treated as proof of injury. I explain this plainly to patients and attorneys in Charlotte.
Why the Term Changed
The 2014 update to the standard disc nomenclature emphasized the term "annular fissure" in place of "annular tear." The radiology committee that endorsed it wrote that the nomenclature's definitions are not intended to imply external causes such as trauma, a relationship to symptoms, or a need for treatment (Williams, AJNR 2014). The nomenclature itself is a system for describing disc shape on imaging (Fardon, Spine J 2014).
A report that still says "annular tear" is describing the same thing. The older word was not meant to say the tear came from an injury.
How Common It Is Without Pain
In a systematic review of 3,110 people with no back pain, annular fissures were found in 19% at age 20 and 29% at age 80 (Brinjikji, AJNR 2015). Roughly one in five pain-free young adults has one.
Is It Linked to Pain?
In a meta-analysis comparing 1,193 asymptomatic and 1,904 symptomatic adults aged 50 or younger, annular fissures were not significantly associated with low back pain. Neither were high-intensity zones, the bright spots on MRI often seen at the site of a fissure (Brinjikji, AJNR 2015 meta-analysis). Disc extrusion, protrusion, bulge, degeneration, Modic type 1 change, and spondylolysis were associated with pain.
That does not mean a fissure can never hurt. It means that, across populations, finding one does not distinguish people with back pain from people without it.
What This Means After a Car Accident
An annular fissure on a post-crash MRI is weak evidence of injury on its own. It cannot be dated from a single study, it is common in pain-free people, and it was not associated with pain in the meta-analysis. Building a case on that word invites an opposing expert to cite the same committee that wrote the definition.
Stronger evidence comes from elsewhere: prior imaging of the same disc without the finding, new symptoms that began with the crash, a neurologic exam that matches the level, and any measurable structural injury such as a herniation that compresses a nerve or excessive motion on flexion and extension X-rays.
For an example of how post-collision imaging findings and outcomes are documented in the peer-reviewed literature, read Dr. Justin Dick's published case report on refractory lumbar pain following a motor vehicle accident in a geriatric patient.
Frequently Asked Questions
What is the difference between an annular fissure and an annular tear?
They are the same finding, a separation in the outer fibers of the disc. The 2014 disc nomenclature emphasized annular fissure in place of annular tear (Williams, AJNR 2014).
Does an annular tear mean I was injured in a car accident?
Not by itself. The standard definitions are not intended to imply trauma, and annular fissures are found in 19% to 29% of people without back pain (Brinjikji, AJNR 2015).
Are annular fissures linked to back pain?
In a meta-analysis of adults 50 or younger, annular fissures and high-intensity zones were not significantly associated with low back pain (Brinjikji, AJNR 2015 meta-analysis).
Can an annular fissure be dated on MRI?
Not from a single study. Prior imaging of the same disc is the most direct way to show whether a fissure was present before a collision.
How does Dr. Justin Dick handle an annular fissure on a post-accident MRI?
Dr. Justin Dick in Charlotte, NC treats it as weak evidence on its own and looks for prior imaging, symptom timing, a matching neurologic exam, and measurable structural findings.
Where can I get an MRI with an annular fissure reviewed in Charlotte, NC?
Dr. Justin Dick, DC, CNMT, ARRT(N)(CT), sees car accident patients at Clear Life Scoliosis and Chiropractic Center, 8814 Rachel Freeman Way, Suite 103, Charlotte, NC 28278, phone 980-368-0766. Personal injury patients are treated on a lien basis, with no out-of-pocket payment at the time of care.
Sources and Evidence Tiers
- Williams AL, Murtagh FR, Rothman SLG, Sze GK. Lumbar disc nomenclature: version 2.0. AJNR Am J Neuroradiol. 2014;35(11):2029. LinkEvidence tier: Editorial by the ASSR/ASNR nomenclature committee (expert consensus)
- Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Lumbar disc nomenclature: version 2.0. Spine J. 2014;14(11):2525-2545. PMID 24768732. LinkEvidence tier: Expert consensus (NASS, ASSR, ASNR task forces)
- Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. PMID 25430861. LinkEvidence tier: Systematic review
- Brinjikji W, Diehn FE, Jarvik JG, et al. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2015;36(12):2394-2399. PMID 26359154. LinkEvidence tier: Systematic review and meta-analysis
About the author. Dr. Justin M. Dick, DC, is the owner and treating clinician at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. He holds dual imaging credentials as a Certified Nuclear Medicine Technologist (CNMT) and as an ARRT-registered technologist in nuclear medicine and CT, ARRT(N)(CT). He is a Senior Fellow of the CLEAR Institute, holds the ISICO World Masters credential, is a SOSORT provisional member, and is a certified DOT medical examiner on the FMCSA National Registry. He has multiple peer-reviewed publications indexed in PubMed and serves as adjunct faculty at Life, Sherman, and Palmer chiropractic colleges.
Service Area
Clear Life Scoliosis and Chiropractic Center sees personal injury and spinal imaging patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, and Fort Mill SC.
Related Pages
- Personal injury and car accident spinal care in Charlotte
- Dr. Justin Dick's research
- Case report: refractory lumbar pain after a motor vehicle accident
- Research and evidence at Clear Life
- Questions and answers
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Clear Life Scoliosis and Chiropractic Center
8814 Rachel Freeman Way, Suite 103
Charlotte, NC 28278
Phone: 980-368-0766
Email: office@clearlifescoliosis.com
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