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Sima S, Chen X, Sheldrick K, Kuan J, Diwan AD. Reconsidering high intensity zones: its role in intervertebral disk degeneration and low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1474-1483. [PMID: 38381388 DOI: 10.1007/s00586-024-08185-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/12/2023] [Accepted: 02/04/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE High intensity zones (HIZ) in the lumbar intervertebral disk (IVD) can be associated with degenerative changes which may ultimately manifest as low back pain (LBP). However, the relationship between the prevalence of HIZ and lumbar degenerative parameters is still unclear. The purpose of this study was to determine the prevalence of HIZ in the lumbar spine, analyze the independent relationship between HIZ and lumbar degenerative parameters measured on MRI and X-ray and determine the association between HIZ and the presence of LBP. METHODS A retrospective review of MRI data, X-ray data, and radiology reports for 136 consecutively recruited patients, above 18-years-age and with both lumbar MRI and X-ray scans was conducted. 57 patients with HIZ were identified. Patients without HIZ (n = 79) made up the control group. RESULTS HIZ was prevalent in 41.9% of patients and in 11.0% of all lumbar IVDs. The odds of developing HIZ were 6.4 (Exp(B) 6.4, 95%CI [3.157-12.988]) and 3.0 (Exp(B) 3.0, 95%CI [1.603, 5.674]) times higher in IVDs with disk bulge/protrusion and nucleus degeneration, respectively. Odds of HIZ was also increased in disks with larger IVD angle (Exp(B) 1.1, 95%CI [1.034, 1.169]). The odds of patients presenting to imaging with LBP was 3.0 (OR 3.0, 95%CI [1.478-6.338]) times higher in the HIZ compared to the control group. CONCLUSIONS HIZ was prevalent in 41.9% of participants that were recruited in this study. Nucleus degeneration, disk bulge/protrusion and increased IVD angle were found to be independently associated with HIZ and since there is an increased likelihood of LBP, we posit that HIZ is likely a symptomatic and clinically meaningful diagnostic tool in the assessment of LBP.
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Affiliation(s)
- Stone Sima
- Spine Labs, St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Xiaolong Chen
- Spine Labs, St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia.
- Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Kyle Sheldrick
- Spine Labs, St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Jeff Kuan
- St. George MRI, Healthcare Imaging, Kirk Place, Kogarah, NSW, Australia
| | - Ashish D Diwan
- Spine Labs, St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
- Spine Service, Department of Orthopaedic Surgery, St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
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van der Graaf JW, Kroeze RJ, Buckens CFM, Lessmann N, van Hooff ML. MRI image features with an evident relation to low back pain: a narrative review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1830-1841. [PMID: 36892719 DOI: 10.1007/s00586-023-07602-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/27/2022] [Accepted: 02/11/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Low back pain (LBP) is one of the most prevalent health condition worldwide and responsible for the most years lived with disability, yet the etiology is often unknown. Magnetic resonance imaging (MRI) is frequently used for treatment decision even though it is often inconclusive. There are many different image features that could relate to low back pain. Conversely, multiple etiologies do relate to spinal degeneration but do not actually cause the perceived pain. This narrative review provides an overview of all possible relevant features visible on MRI images and determines their relation to LBP. METHODS We conducted a separate literature search per image feature. All included studies were scored using the GRADE guidelines. Based on the reported results per feature an evidence agreement (EA) score was provided, enabling us to compare the collected evidence of separate image features. The various relations between MRI features and their associated pain mechanisms were evaluated to provide a list of features that are related to LBP. RESULTS All searches combined generated a total of 4472 hits of which 31 articles were included. Features were divided into five different categories:'discogenic', 'neuropathic','osseous', 'facetogenic', and'paraspinal', and discussed separately. CONCLUSION Our research suggests that type I Modic changes, disc degeneration, endplate defects, disc herniation, spinal canal stenosis, nerve compression, and muscle fat infiltration have the highest probability to be related to LBP. These can be used to improve clinical decision-making for patients with LBP based on MRI.
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Affiliation(s)
- Jasper W van der Graaf
- Diagnostic Image Analysis Group, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
- Department of Orthopedic Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
| | - Robert Jan Kroeze
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Constantinus F M Buckens
- Department of Medical Imaging, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Nikolas Lessmann
- Diagnostic Image Analysis Group, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Miranda L van Hooff
- Department of Orthopedic Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
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Wan ZY, Zhang J, Shan H, Liu TF, Song F, Samartzis D, Wang HQ. Epidemiology of Lumbar Degenerative Phenotypes of Children and Adolescents: A Large-Scale Imaging Study. Global Spine J 2023; 13:599-608. [PMID: 33843321 DOI: 10.1177/21925682211000707] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE Recently, there has been a rise in children and adolescents developing low back pain and/or sciatica. Degenerative lumbar spine MRI phenotypes can occur in this population but reports have been sporadic and the true incidence of such spine changes remains debatable. As such, the study aimed to address the epidemiology of MRI phenotypes of the lumbar spine in this young population. METHODS 597 children and adolescents with lumbar MRIs were included in the study. T1- and T2-weighted lumbar images from L1/2 to L5/S1 were analyzed in axial and sagittal planes. Global phenotype assessment was performed of each level and based on established nomenclature protocols. RESULTS The cohort consisted of 57.3% (342) boys and 42.7% (255) girls, with a mean age of 10.75 ± 5.25 years (range: 0 to 18 years). The prevalence of imaging findings of lumbar disc degeneration (LDD) and lumbar disc herniation (LDH) were 2.2% (95% CI: 0.93-3.43) and 5.8% (95%CI: 2.58-8.99), respectively. There was significant difference between each disc segment from L1/2 to L5/S1 for both LDD and LDH. Schmorl's nodes were noted in 16 cases (2.7%, youngest case as 15 years), with 11 boys (68.8%) and most frequent segment as L3/4. Modic changes and high-intensity zones were absent in this cohort. CONCLUSIONS LDD can emerge as early as the first decade of life with Schmorl's nodes, without additional specific phenotypes, including Modic changes and high-intensity zones. The study provides valuable information of a unique age group that is often under-represented but equally important as adults.
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Affiliation(s)
- Zhong-Yuan Wan
- Department of Orthopedics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jun Zhang
- Department of Orthopedics, Baoji Central Hospital, Baoji, Shaanxi Province, People's Republic of China
| | - Hua Shan
- Institute of Integrative Medicine, 107652Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, People's Republic of China
| | - Tang-Fen Liu
- Institute of Integrative Medicine, 107652Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, People's Republic of China
| | - Fang Song
- Department of Stomatology, PLA Rocket Force Characteristic Medical Center, Beijing, People's Republic of China
| | - Dino Samartzis
- Department of Orthopaedic Surgery, 2468Rush University Medical Center, Chicago, IL, USA
| | - Hai-Qiang Wang
- Institute of Integrative Medicine, 107652Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, People's Republic of China
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Nguyen AQ, Harada GK, Leverich KL, Khanna K, Louie PK, Basques BA, Tao Y, Galbusera F, Niemeyer F, Wilke HJ, An HS, Samartzis D. High-Intensity Zones on MRI of the Cervical Spine in Patients: Epidemiology and Association With Pain and Disability. Global Spine J 2022; 12:829-839. [PMID: 33203250 PMCID: PMC9344501 DOI: 10.1177/2192568220966328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES This study aimed to address the prevalence, distribution, and clinical significance of cervical high-intensity zones (HIZs) on magnetic resonance imaging (MRI) with respect to pain and other patient-reported outcomes in the setting of patients that will undergo an anterior cervical discectomy and fusion (ACDF) procedure. METHODS A retrospective cohort study of ACDF patients surgically treated at a single center from 2008 to 2015. Based on preoperative MRI, HIZ subtypes were identified as either traditional T2-hyperintense, T1-hypointense ("single-HIZs"), or combined T1- and T2-hyperintense ("dual-HIZs"), and their level-specific prevalence was assessed. Preoperative symptoms, patient-reported outcomes, and disc degeneration pathology were assessed in relation to HIZs and HIZ subtypes. RESULTS Of 861 patients, 58 demonstrated evidence of HIZs in the cervical spine (6.7%). Single-HIZs and dual-HIZs comprised 63.8% and 36.2% of the overall HIZs, respectively. HIZs found outside of the planned fusion segment reported better preoperative Neck Disability Index (NDI; P = .049) and Visual Analogue Scale (VAS) Arm (P = .014) scores relative to patients without HIZs. Furthermore, patients with single-HIZs found inside the planned fusion segment had worse VAS Neck (P = .045) and VAS Arm (P = .010) scores. In general, dual-HIZ patients showed no significant differences across all clinical outcomes. CONCLUSIONS This is the first study to evaluate the clinical significance of HIZs in the cervical spine, noting level-specific and clinical outcome-specific variations. Single-HIZs were associated with significantly more pain when located inside the fusion segment, while dual-HIZs showed no associations with patient-reported outcomes. The presence of single-HIZs may correlate with concurrent spinal pathologies and should be more closely evaluated.
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Affiliation(s)
| | | | | | | | | | | | - Youping Tao
- Rush University Medical
Center, Chicago, IL, USA
| | - Fabio Galbusera
- Rush University Medical
Center, Chicago, IL, USA,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Frank Niemeyer
- Rush University Medical
Center, Chicago, IL, USA,Ulm University Medical
Centre, Ulm, Germany
| | - Hans-Joachim Wilke
- Rush University Medical
Center, Chicago, IL, USA,Ulm University Medical
Centre, Ulm, Germany
| | - Howard S. An
- Rush University Medical
Center, Chicago, IL, USA
| | - Dino Samartzis
- Rush University Medical
Center, Chicago, IL, USA,Dino Samartzis, DSc, Department of
Orthopaedic Surgery, Rush University Medical Center, Orthopaedic Building, Suite
204-G, 1611W. Harrison Street, Chicago, IL 60612, USA.
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