Question
I have an annular tear at L5-S1 for 2 years before it was found (nobody would listen to me).  I had the IDET procedure and it didn't work. I am still having pain radiating down my legs into my feet and heals making it very difficult to walk.  I tried IDD therapy and did about 30-34 treatments and it didn't help the leg pain.  My question is this: Does IDD therapy treat annular tears?

Answer
Dear Leiah,

IDD therapy does not really treat annular tears. Since you use the terms IDD therapy I am assuming that you are either utilizing the DRX 9OOO or the Accuspina machine as they use these terms in their advertising.  

The concept behind IDD therapy is the use of an electrical tractioning device to create a negative pressure are inside the center of the disk (nucleus pulposus) so that the disk material can be sucked back inward...these theories were proposed by Cyriax, however research has confirmed that intradiscal pressures actually increase rather than decrease.  But, it still has some therapeutic value because it creates motion at the disk and vertebral bodies which will help push nutrients from the bone marrow of the vertebra into the disk material.  This is called imbibition.  Bottom line here is the treatment is focused on opening up the joint spaces, try and reduce bulging disk material, and increase healing, specifically targeting the inner portions of the disk rather than the outer.

An annular tear in it self does not mean that you actually have a bulge.  There are three separate layers of the annulus and they all run in different angles to help prevent a full thickness tear.  The big problem is that the disk heals very poorly with poor scar formation when it does heal due to the limited blood supply.  With a poor blood supply, the nutrients needed for repair do not get to the target tissue.  Check out this quote:

揟he spinal injury weakens the spine and predisposes the patient to further injury, regardless of type and extent of damage. This phenomenon is especially true when protection of the injured part is not adequate. Ligaments and muscles heal only by scar formation, and the annulus fibrosis of the disk is almost powerless to heal tears of its substance.?David B. Levine, M.D., The Painful Back, Page 451, Chapter 92

Now concerning pain management procedures, the offending tissue must be targeted for the pain to be relieved.  The nerve that supplies information to the annulus is the sinu vertebral nerve a.k.a.(recurrent meningeal nerve), which is likely the cause of the pain. This nerve comes off of the individual nerve roots in the back, and can cause enough irritation to effect the nerves that go down the leg.

The fact that you have not had god results with conservative care or IDET is not promising.  However, you may wish to try alternative pain management techniques such as a radiofrequency neurotomy, or an epidural injection.   Good luck Leiah.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net