0:00

I'd like to talk briefly about annular fissures.

0:05

Annular fissures is the term that the consensus

0:10

group settled on with regard to the areas of high

0:14

signal intensity in the periphery of the disc.

0:18

They advised not using the term annular tear

0:23

because that term generally implies trauma and had

0:29

been used in medical legal situation to suggest

0:33

an acute injury that may be associated

0:36

with a traumatic event.

0:37

Annular fissures are thought to actually represent

0:40

a more degenerative process,

0:42

rather than a traumatic process.

0:45

Now, there are many different types of fibers that are

0:48

in the annulus, including concentric

0:51

and radial and transverse fibers.

0:53

When we see the bright signal intensity in the

0:56

fissure, we are not implying which of those fibers

1:00

is being injured.

1:03

Here we have at the L5-S1 level,

1:06

an area where there is high signal intensity on

1:09

the T2-weighted scan, where there is an annular fissure.

1:14

Annular fissures typically do show contrast enhancement.

1:20

This is a post-gad T1-weighted scan, and you see

1:25

that there is enhancement of

1:27

that same annular fissure.

1:31

Fletcher Munter,

1:34

one of my clinical fellows from the army,

1:37

and I did a study that is getting a little bit

1:40

dated back in 2002, in which we looked at annular

1:45

fissures on MRI scans and went back through the

1:48

patient's records to see how long

1:51

an annular fissure will persist.

1:54

And we were surprised to find that annular

1:57

fissures may persist for years,

1:59

even decades. We had, as you can see,

2:03

some patients who had annular fissures that were even

2:07

as long as 20 years previous, that remained bright

2:12

in signal intensity on T2-weighted scan and

2:15

remained, showing contrast enhancement.

2:19

So the point of this is that the presence of an

2:23

annular fissure does not imply acuity of the injury.

2:26

That is, that if you see high signal intensity in the

2:29

fissure or enhancement in the fissure, it doesn't

2:32

mean that that degenerative event, or let's say

2:35

even traumatic event, that that event occurred recently.

2:40

That high signal intensity and that

2:42

enhancement may persist for many years

2:45

thereafter, if not, indefinitely.