After a really bad bout of back pain, I had an MRI done. It showed I have a fissure in the outer covering of my disc at L45. How do you treat something like this?

Discs are made up of two parts. There is the center or core, a soft gel-like substance called the nucleus pulposus (NP). The NP is surrounded by a fibrous covering called the annulus.

Fissures are cracks in the surface of the annulus. They can occur as a result of gradual wear and tear associated with aging and the degenerative process. Or they can develop as a result of an acute injury.

In either case, it's possible for the body to repair the damage itself. No treatment (outside of good nutrition and avoiding extreme contact sports) may be needed. If you had an MRI during the healing phase, the image might show a bright annular signal indicating inflammation. Over time, the signal might return to normal as the healing process takes place.

If the tear extends into the center of the disc called the nucleus propulsus, then disc protrusion and eventual herniation may develop. Initial treatment may be the same for either type of injury with a wait-and-see approach. Many people can recover from this with conservative care.

Your orthopedic surgeon can review with you all of your options. Most doctors advise conservative care for at least six months before more invasive treatment (such as surgery) is considered.

Eugene Carragee, MD, et al. Are First-Time Episodes of Serious LBP Associated with New MRI Findings? In The Spine Journal. November 2006. Vol. 6. No. 6. Pp. 624-635.

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