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Spine J. 2020 Mar 3. pii: S1529-9430(20)30082-6. doi: 10.1016/j.spinee.2020.02.015. [Epub ahead of print]

Lumbar high-intensity zones on MRI: imaging biomarkers for severe, prolonged low back pain and sciatica in a population-based cohort.

Author information

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%). Disk 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.

KEYWORDS:

HIZ; High intensity zone; Low back; Lumbar; MRI; Pain; Phenotype; Spine

PMID:
32135303
DOI:
10.1016/j.spinee.2020.02.015
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