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  #21  
Old 01-02-2017, 06:26 AM
FutureRobot FutureRobot is offline
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Once a disc is dehydrated, wouldn't it have less inflammatory substance to leak out? I thought annular tears mostly cause pain due to the nucleus pulposus leaking out and causing inflammation with the nerves. I've also heard that the tears cause nerve fibers to grow within the disc, which can contribute to discogenic pain and even referred pain down the leg.

If the disc is dehydrated, I don't see how there would be more fluid to leak out. Isn't this why they say that as you get older, discogenic pain tends to decrease, because the disc stiffens and there is less movement and/or leakage? I'm dealing with an HIZ tear in a degenerating discright now, so if you've come across any info regarding this, I'd love to see it.
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HIZ tear at l5 s1 with mild disc height reduction and mild dehydration.
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  #22  
Old 01-02-2017, 02:22 PM
Blizzaga Blizzaga is offline
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I have understood that dehydration of the disc permanently changes the chemistry inside the disc, causing the substance to be even more inflammatory (?). Unless your disc is completely gone, there is still plenty of substance to leak out. Additionally, I read that the dehydration causes the anulus fibrosus to become mechanically weaker, making it difficult to keep intact/prevent further tearing. You are correct that eventually the disc should stiffen and turn into bone (auto-fuse) when you get old enough. Then the pain should subside. But it may be a long wait and there may be a risk of the disc wearing out before fusing, which may cause other problems as well (spinal stenosis?).

One of the doctors I visited noted that I have High Intensity Zone visible in my MRIs. I can't remember if it was L4L5 or L5S1 or both, but looking at my old MRI now, I think I see it at L4L5. Here is an example of an article discussing this issue:
http://europepmc.org/abstract/MED/10766075

It is tricky. One doctor will say that the pain comes from HIZ, another says it is the fluid mechanically pressing on the nerve root, a third doctor says it is the end plates and the fourth doctor says it is inflammatory proteins. I suspect that the exact role of pain generation in discs is not fully agreed on yet. ADR surgery should fix all these potential pain generators, so it may not be necessary to know which one was the culprit.
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2015 Lost ability to sit
2016 Gradually worsening despite conservative treatment
2016 L4-L5, L5-S1 activ L success!
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  #23  
Old 01-02-2017, 02:46 PM
pittpete pittpete is offline
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This pretty much explains a lot.
http://www.chirogeek.com/000_Anular_Tear_1.htm
I've followed this guy for 10+ years
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Born 1970/1995-Hurt at work/1996-Right disc fragment L4-L5 discectomy-On/off back pain,no serious leg pain until/2007-Right herniation L5-S1,recurrent small herniation at L4-L5 with unbearable leg pain/6/08 discectomy L5-S1/leg pain relieved/occaisional mechanical pain/2012-Cymblata 60 mg,occasional aleve/2014-LB pain not debilitating but chronic,Rhizotomy relieves facet pain on right side/2015-L4-S1 facets shot/4/15 PLIF L4-S1 with facectomy
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  #24  
Old 01-02-2017, 04:24 PM
FutureRobot FutureRobot is offline
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Yes, chirogeek is great! I actually had a personal consult with him and he was very informative. He told me - and it's on his site - that eventually time can heal a tear, but it takes a longgggg time....and it will never be fully healed. I'm talking years of time, and most in severe pain can't afford to wait.

Blizzaga, I've read studies showing that HIZ is a pain generator up to 90% of the time. My guess is that your pain at least somewhat comes from the tear. It's a fairly good indicator imo.

This is the first I've heard that a dehydrated disc would cause more pain from a tear going forward. This concerns me for sure.
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HIZ tear at l5 s1 with mild disc height reduction and mild dehydration.
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