Jason Pui Yin Cheung1, Keith Dip Kei Luk2. 1. Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, 5/F Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China. cheungjp@hku.hk. 2. Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, 5/F Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
Abstract
PURPOSE: The purpose of this study was to review the current understanding of high-intensity zones (HIZ) in the lumbar spine with particular attention to its imaging phenotype and clinical relevance. METHODS: A review was conducted of studies related to HIZ. Particular attention was made to imaging phenotypes and classification, and its relationship with discogenic low back pain (LBP). RESULTS: The most current classification system of HIZ is based on location (anterior and posterior), morphology (round, fissure, vertical, rim, or giant types), and its appearance on both T1- and T2-weighted magnetic resonance imaging (MRI). HIZ are commonly manifested with disc degeneration. Hence, both conditions share similar risk factors such as the effect of frequent and prolonged disc loading. The clinical significance of HIZ however is not conclusive. Provocative discography is not sensitive (~ 70%) for eliciting a concordant pain response. Population-based studies have conflicting results regarding the prevalence (14-63%) of HIZ and its correlation with LBP. CONCLUSIONS: HIZ are likely a risk factor for discogenic LBP. However, its etiology and pathophysiology are not well understood. Some clinical studies suggest a link between its occurrence and LBP. However, the results are not consistent as a result of studies which are underpowered and based on heterogeneous study populations, lacking control groups, and without standardized imaging phenotypes. HIZ may be an important pain biomarker that should be further studied. With more modern MRI technology and a detailed classification system, future large-scale population studies will improve our knowledge on its role in the disc degeneration cascade and development of LBP.
PURPOSE: The purpose of this study was to review the current understanding of high-intensity zones (HIZ) in the lumbar spine with particular attention to its imaging phenotype and clinical relevance. METHODS: A review was conducted of studies related to HIZ. Particular attention was made to imaging phenotypes and classification, and its relationship with discogenic low back pain (LBP). RESULTS: The most current classification system of HIZ is based on location (anterior and posterior), morphology (round, fissure, vertical, rim, or giant types), and its appearance on both T1- and T2-weighted magnetic resonance imaging (MRI). HIZ are commonly manifested with disc degeneration. Hence, both conditions share similar risk factors such as the effect of frequent and prolonged disc loading. The clinical significance of HIZ however is not conclusive. Provocative discography is not sensitive (~ 70%) for eliciting a concordant pain response. Population-based studies have conflicting results regarding the prevalence (14-63%) of HIZ and its correlation with LBP. CONCLUSIONS: HIZ are likely a risk factor for discogenic LBP. However, its etiology and pathophysiology are not well understood. Some clinical studies suggest a link between its occurrence and LBP. However, the results are not consistent as a result of studies which are underpowered and based on heterogeneous study populations, lacking control groups, and without standardized imaging phenotypes. HIZ may be an important pain biomarker that should be further studied. With more modern MRI technology and a detailed classification system, future large-scale population studies will improve our knowledge on its role in the disc degeneration cascade and development of LBP.
Authors: Eva Koetsier; Sander M J van Kuijk; Paolo Maino; Jasmina Dukanac; Luca Scascighini; Alessandro Cianfoni; Pietro Scarone; Dominique E Kuhlen; Markus W Hollman; Jan-Willem Kallewaard Journal: BMJ Open Date: 2022-03-30 Impact factor: 2.692
Authors: Austin Q Nguyen; Garrett K Harada; Kayla L Leverich; Krishn Khanna; Philip K Louie; Bryce A Basques; Youping Tao; Fabio Galbusera; Frank Niemeyer; Hans-Joachim Wilke; Howard S An; Dino Samartzis Journal: Global Spine J Date: 2020-11-18
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