For some veterans with service-connected annular tears at multiple lumbar levels, intra-annular fibrin injection may offer an alternative path when conventional treatments have not provided lasting relief. This case study describes one patient’s experience — outcomes are individual, and candidates are evaluated on a case-by-case basis to determine whether this approach is appropriate for their condition.

Patient Overview

The patient is a retired U.S. Army Staff Sergeant with 12 years of infantry service. His military career included repeated heavy rucking under full combat load and multiple parachute jumps — physical demands that placed sustained compressive and rotational stress on the lumbar spine. After separation, he carried a VA service-connected disability rating for chronic low back pain linked to his active-duty service.

The Challenge

Imaging confirmed annular tears at two levels: L4-L5 and L5-S1. He reported pain levels of 7–8 out of 10 on most days, with significant limitations in daily activity. Walking long distances was no longer comfortable, and he had stepped back from coaching his son’s youth baseball team due to the physical demands. He described the pain as a constant presence that had reshaped nearly every part of his civilian life.

After years of conservative care, an orthopedic surgeon told him spinal fusion was the only remaining option. He was not ready to accept that conclusion without exploring alternatives first.

Previous Treatments Tried

Before arriving at ValorSpine, this patient had worked through an extensive list of conventional interventions over several years:

• Four rounds of epidural steroid injections (ESIs), providing diminishing relief with each cycle
• Formal physical therapy programs on two separate occasions
• Chiropractic care over an extended period
• Prescription medications for pain management
• Acupuncture

None of these approaches produced durable improvement. His functional limitations continued to worsen, and his VA treatment team had reached the same conclusion as the orthopedic surgeon: surgical fusion was the logical next step.

Our Approach

Our clinical team reviewed his complete imaging, VA records, and treatment history before any decisions were made. Evaluation for biologic disc repair is not automatic — candidacy depends on the nature and extent of annular damage, overall disc integrity, prior treatment history, and the patient’s health profile.

In this case, our team determined he was an appropriate candidate for intra-annular fibrin injection at both L4-L5 and L5-S1. The goal of this fibrin procedure is to support the body’s own repair process by introducing a biologic scaffold into the damaged annular tissue — targeting the source of disc disruption rather than masking pain signals.

Expert Take

Veterans presenting with multi-level annular tears from high-impact military service represent one of the more complex evaluation profiles we see. The pattern of cumulative mechanical stress from rucking and jump activity creates a specific injury signature. When we assess a patient like this, we are looking at whether disc architecture still supports a biologic approach — because the procedure works with remaining disc structure, not in spite of its absence. For patients who qualify, annular tear repair at multiple levels is possible, though recovery timelines and outcomes vary by individual case.

Treatment Process

The intra-annular fibrin injection was performed at both levels during a single outpatient procedure. The approach is image-guided to ensure precise delivery to the target site within the annular tear. Because the procedure is minimally invasive and does not involve implants, hardware, or bone fusion, there is no lengthy hospital stay and no surgical recovery period of the type associated with spinal fusion.

Following the procedure, our clinical team provided a structured recovery protocol. Activity was moderated during the initial healing phase, with gradual reintroduction of movement as tolerated. We worked with the patient to set realistic expectations — progress in biologic disc repair is not immediate, and patients are counseled that the tissue remodeling process unfolds over weeks and months.

The Results

At his six-month follow-up, this patient reported a pain level of approximately 2 out of 10 — a substantial change from the 7–8 range he described before treatment. He reported returning to hiking and had resumed coaching his son’s baseball team.

These are this patient’s self-reported outcomes. Results vary by case. Not every patient with multi-level annular tears will experience the same degree of improvement, and individual factors — including the extent of disc damage, overall health, and adherence to recovery protocols — influence what is possible. Outcomes with intra-annular fibrin injection are not guaranteed, and candidacy evaluation exists precisely to identify patients for whom the procedure is most likely to be beneficial.

Key Takeaways

1. Multi-level annular tears at L4-L5 and L5-S1 are a recognized pattern in veterans with high-impact infantry service histories; each case requires individual evaluation to determine appropriate treatment options.
2. Exhausting conventional treatments — including multiple rounds of injections, physical therapy, and medication — does not automatically mean spinal fusion is the only path forward. Understanding when to seek a second opinion before spinal fusion is an important step many veterans benefit from exploring.
3. Candidacy for intra-annular fibrin injection is determined through thorough evaluation of imaging, treatment history, and disc integrity — not every patient qualifies, and that evaluation exists to protect patients from procedures that may not be appropriate for their anatomy.
4. Biologic disc repair is an outpatient, minimally invasive approach that targets annular tears directly; it does not involve implants or bone fusion and carries a different recovery profile than surgical alternatives. Learn more about annular tear repair as a non-surgical approach.
5. Reported outcomes from fibrin disc treatment vary by individual. Pain reduction, functional improvement, and return to activity are possible for some patients — but recovery timelines and results differ, and no outcome is guaranteed.
6. Veterans with service-connected back conditions have options for evaluation outside the VA system. A veteran’s guide to biologic disc repair outlines what to expect from the evaluation and treatment process.

“I had done everything they told me to do. Four shots, two rounds of PT, chiropractor, medications — nothing stuck. When they said fusion was my only option, I just wasn’t ready to sign up for that. Coming to ValorSpine was the first time someone actually looked at my specific imaging and my history and said, here’s what we’re working with and here’s whether this could help you. Six months later I’m hiking again and I’m back on the baseball field with my son. I’m not saying I’m cured — I still have some days — but I’m back in my life.”

— Staff Sergeant Michael Jensen (Ret.), Army Infantry

Every veteran’s spine history is different, and what worked for one patient may not be appropriate for another. If you are a veteran who has been told fusion is the only option and want to understand whether biologic disc repair might be worth evaluating for your specific case, our veteran’s guide to biologic disc repair walks through the candidacy process, what to bring to an evaluation, and what realistic expectations look like.