Masatoshi Teraguchi1, Jason P Y Cheung2, Jaro Karppinen3, Cora Bow2, Hiroshi Hashizume4, Keith D K Luk2, Kenneth M C Cheung2, Dino Samartzis5. 1. Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China; Spine Care Center, Wakayama Medical University, Kihoku Hospital, Ito, Wakayama, Japan; Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan. Electronic address: m-tera@wakayama-med.ac.jp. 2. Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China. 3. Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Finnish Institute of Occupational Health, Oulu, Finland. 4. Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan. 5. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA; International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA. Electronic address: Dino_Samartzis@rush.edu.
Abstract
BACKGROUND CONTEXT: There is often discrepancy between clinical presentation and lumbar magnetic resonance imaging (MRI) findings. PURPOSE: The purpose of this study was to assess the relationship of high-intensity zones (HIZs) on MRI with low back pain (LBP), sciatica, and back-related disability. STUDY DESIGN: Cross-sectional, population-based Southern Chinese cohort study. PATIENT SAMPLE: Of 1,414 possible participants, data from 1,214 participants (453 males, 761 females; mean age of 48.1±6.3 years) were included. OUTCOME MEASURES: Presence of single-level, homogeneous multilevel (same type HIZs of morphology and topography) and heterogeneous multilevel (mixed type HIZs of morphology and topography) HIZs and other MRI phenotypes were assessed at each level with T2-weighted 3T sagittal MRI of L1-S1. Associations with LBP, sciatica and Oswestry Disability Index were correlated with HIZ profiles. RESULTS: In all, 718 individuals had HIZs (59.1%). Disc degeneration/displacement were more prevalent in HIZ individuals (p<.001). HIZ subjects experienced prolonged severe LBP more frequently (39.6% vs. 32.5%; p<.05) and had higher Oswestry Disability Index scores (10.7±13.7 vs. 8.9±11.3; p<.05). Posterior multilevel HIZ were significantly associated with prolonged severe LBP (OR: 2.18; 95% CI:1.42-3.37; p<.05) in comparison to anterior only, anterior/posterior or other patterns of HIZ. Multilevel homogeneous or heterogeneous HIZs were significantly associated with prolonged, severe LBP (OR: 1.53-1.57; p<.05). Individuals with homogeneous HIZs had a higher risk of sciatica (OR: 1.51, 95% CI: 1.01-2.27; p<.05). CONCLUSIONS: This is the first large-scale study to note that lumbar HIZs, and specific patterns therein, are potentially clinically-relevant imaging biomarkers that are independently and significantly associated with prolonged/severe LBP and sciatica. HIZs, especially homogenous multilevel HIZ, should be noted in the global pain imaging phenotype assessment.
BACKGROUND CONTEXT: There is often discrepancy between clinical presentation and lumbar magnetic resonance imaging (MRI) findings. PURPOSE: The purpose of this study was to assess the relationship of high-intensity zones (HIZs) on MRI with low back pain (LBP), sciatica, and back-related disability. STUDY DESIGN: Cross-sectional, population-based Southern Chinese cohort study. PATIENT SAMPLE: Of 1,414 possible participants, data from 1,214 participants (453 males, 761 females; mean age of 48.1±6.3 years) were included. OUTCOME MEASURES: Presence of single-level, homogeneous multilevel (same type HIZs of morphology and topography) and heterogeneous multilevel (mixed type HIZs of morphology and topography) HIZs and other MRI phenotypes were assessed at each level with T2-weighted 3T sagittal MRI of L1-S1. Associations with LBP, sciatica and Oswestry Disability Index were correlated with HIZ profiles. RESULTS: In all, 718 individuals had HIZs (59.1%). Disc degeneration/displacement were more prevalent in HIZ individuals (p<.001). HIZ subjects experienced prolonged severe LBP more frequently (39.6% vs. 32.5%; p<.05) and had higher Oswestry Disability Index scores (10.7±13.7 vs. 8.9±11.3; p<.05). Posterior multilevel HIZ were significantly associated with prolonged severe LBP (OR: 2.18; 95% CI:1.42-3.37; p<.05) in comparison to anterior only, anterior/posterior or other patterns of HIZ. Multilevel homogeneous or heterogeneous HIZs were significantly associated with prolonged, severe LBP (OR: 1.53-1.57; p<.05). Individuals with homogeneous HIZs had a higher risk of sciatica (OR: 1.51, 95% CI: 1.01-2.27; p<.05). CONCLUSIONS: This is the first large-scale study to note that lumbar HIZs, and specific patterns therein, are potentially clinically-relevant imaging biomarkers that are independently and significantly associated with prolonged/severe LBP and sciatica. HIZs, especially homogenous multilevel HIZ, should be noted in the global pain imaging phenotype assessment.
Authors: Cindy G Boer; Konstantinos Hatzikotoulas; Lorraine Southam; Lilja Stefánsdóttir; Yanfei Zhang; Rodrigo Coutinho de Almeida; Tian T Wu; Jie Zheng; April Hartley; Maris Teder-Laving; Anne Heidi Skogholt; Chikashi Terao; Eleni Zengini; George Alexiadis; Andrei Barysenka; Gyda Bjornsdottir; Maiken E Gabrielsen; Arthur Gilly; Thorvaldur Ingvarsson; Marianne B Johnsen; Helgi Jonsson; Margreet Kloppenburg; Almut Luetge; Sigrun H Lund; Reedik Mägi; Massimo Mangino; Rob R G H H Nelissen; Manu Shivakumar; Julia Steinberg; Hiroshi Takuwa; Laurent F Thomas; Margo Tuerlings; George C Babis; Jason Pui Yin Cheung; Jae Hee Kang; Peter Kraft; Steven A Lietman; Dino Samartzis; P Eline Slagboom; Kari Stefansson; Unnur Thorsteinsdottir; Jonathan H Tobias; André G Uitterlinden; Bendik Winsvold; John-Anker Zwart; George Davey Smith; Pak Chung Sham; Gudmar Thorleifsson; Tom R Gaunt; Andrew P Morris; Ana M Valdes; Aspasia Tsezou; Kathryn S E Cheah; Shiro Ikegawa; Kristian Hveem; Tõnu Esko; J Mark Wilkinson; Ingrid Meulenbelt; Ming Ta Michael Lee; Joyce B J van Meurs; Unnur Styrkársdóttir; Eleftheria Zeggini Journal: Cell Date: 2021-08-26 Impact factor: 41.582
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