Introduction
Low back pain is one of the most common reasons patients seek medical care, and not all back pain is the same. In Part 1 of Dr. Valastro’s Discogenic Back Pain Series, we introduced the concept of discogenic pain – pain that originates directly from the spinal disc.
In this post, we’ll compare two common types of disc injury, herniated discs and annular tears, to help patients and clinicians better understand their differences in cause, symptoms, diagnosis, and potential treatment pathways.
First, some anatomy
The intervertebral disc has two main components. The outer ring of thick, fibrous connective tissue is called the annulus fibrosis. The center, more gelatinous material is called the nucleus pulposis. Together, these structures provide stability and shock absorption in the disc. The strength and integrity of the annulus fibrosis keep the softer nucleus pulposis contained within the disc space.
Herniated Discs
A herniation occurs when there is significant pressure through a disc, and the annulus fibrosus cannot keep the disc contents contained. The annulus bulges and the disc pushes- or herniates- outside of the disc space. This herniation is often into the spinal canal or neural foramen, where the nerve roots travel. Therefore, the symptoms associated with a herniated disc are usually related to compression or irritation of those nerve roots.
Symptoms:
- Sharp, radiating pain into the leg, trunk, or arm (for lumbar, thoracic, and cervical levels respectively).
- May include numbness, tingling, or weakness along the affected nerve root.
- Often triggered by an acute injury.
Diagnosis:
- Physical exam findings can include nerve tension signs (positive straight leg raise), and alterations in sensation or muscle strength along the nerve root distribution.
- MRI typically shows disc material pressing on adjacent nerve roots, making this injury visually easy to detect.
What Is Discogenic Pain?
Discogenic pain refers to pain coming from the disc itself, rather than pain from the disc pushing onto something else. There are nerve endings on the outer edges of the discs, so when they are damaged or degenerated, they can sense pain.
- Typically felt deep in the lower back, and can be sharp or dull.
- Pain can flare up with certain activities, such as prolonged sitting, bending forward, or lifting.
- Unlike a herniated disc, discogenic pain does not usually radiate into the legs or arms.
Annular Tears
An annular tear is a disruption of the outer ring of the disc (annulus fibrosus), without significant disc material protrusion. This is one of the most common sources of discogenic back pain.
Symptoms:
- Localized low back pain (if lumbar), often described as deep and aching with periods of sharper intensity.
- Pain tends to worsen with sitting or forward bending.
- Less likely to cause numbness, tingling, or weakness, since the nerve root is usually not compressed.
Diagnosis:
- Annular tears may appear as “high-intensity zones” on MRI, or a bright area in the perimeter of the disc, but sometimes the findings are more subtle.
- Diagnosis relies heavily on history, physical exam, and clinical correlation.
Research suggests that biologic approaches like platelet-rich plasma (PRP) injections may help reduce pain and improve function in carefully selected patients with discogenic back pain (1, 2).
Key Differences at a Glance
| Feature | Herniated Disc | Annular Tear |
| Pain type | Sharp, radiating, nerve-based | Sharp or dull, deep, localized |
| Leg/arm symptoms | Numbness, tingling, weakness | Typically absent |
| Cause | Acute injury, heavy lifting, trauma | Acute injury or repetitive stress |
| MRI findings | Mechanical nerve compression | High-intensity zones, disc color changes |
Why This Matters for Patients
Not all disc problems are surgical. The most severe herniated discs that are leading to functional loss may require a surgical resection, and that can lead to positive results. Annular tears don’t have an easy surgical solution. However, many will respond to conservative or biologic approaches.
Clinical studies show that orthobiologics, including PRP (platelet-rich plasma) and BMC (bone marrow concentrate, which contains your own stem cells) can reduce pain and improve function in discogenic pain patients without requiring surgery (1, 2, 3). These approaches are being actively studied and provide new hope for patients who want to avoid spinal fusion or discectomy.
Conclusion
Understanding the difference between herniated discs and annular tears is critical for accurate diagnosis and treatment. The source of pain is different between these two scenarios, and therefore the treatment strategies differ as well.
As Dr. Valastro continues this series, we’ll explore how different treatment strategies, from physical therapy to advanced biologics, can be tailored to each type of disc injury. At New Regeneration Orthopedics, we are committed to understanding the root cause of your pain and finding innovative, non-surgical, solutions to get you back to doing what you love.
References
- Elabd C, et al. Intra-discal injection of autologous, hypoxic cultured bone marrow-derived mesenchymal stem cells in five patients with chronic lower back pain: A long-term safety and feasibility study. J Transl Med. 2016;14:253.
- Tuakli-Wosornu YA, et al. Lumbar intradiskal platelet-rich plasma (PRP) injections: A prospective, double-blind, randomized controlled study. PM&R;. 2016;8(1):1-10
- Pettine KA, et al. Autologous bone marrow concentrate intradiscal injection for the treatment of degenerative disc disease with 2-year follow-up. Int Orthop. 2015;39(12):2415-2422.
- Lutz, C., Cheng, J., Prysak, M. et al. Clinical outcomes following intradiscal injections of higher-concentration platelet-rich plasma in patients with chronic lumbar discogenic pain. International Orthopaedics (SICOT) 46, 1381–1385 (2022).
