Temporal Association of Annular Tears and Nuclear Degeneration: Lessons from the Pediatric Population

Examples of nuclear degeneration and annular tears. A, Sagittal T2-weighted image of the lumbar spine in a 16-year-old girl with a grade 1 annular tear at L5–S1 level (arrow). The tear is considered radial based on less conspicuous intermediate signal intensity extending across almost the entire thickness of the annulus (arrowhead). Nuclear degeneration is noted at this level with loss of signal intensity and minimal height loss. This disk was graded 4 on both signal-intensity and degeneration scales. Note the absence of annular tears and preserved signal intensity of the nucleus at L3–4 and L4–5 levels. B, Sagittal T2-weighted image of the lumbar spine from a 17-year-old boy with a grade 3 radial tear at L4–5 (arrow), a grade 2 radial tear at L5–S1 (arrow), and a grade 3 nonradial tear (arrowhead) at the L3–4 level. Disks at all these levels were assigned a signal-intensity grade of 1 (L3–4 and L4–5) or 2 (L5-S1) and a degeneration grade of 2. C, Parasagittal T2-weighted image demonstrates radial (arrows) and nonradial (arrowhead) tears in the foraminal zones of the disks in an 18-year-old girl.