High-Intensity Zones on MRI of the Cervical Spine in Patients: Epidemiology and Association With Pain and Disability

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.

Assessment of the correlation between clinical and radiological outcomes in patients suffering from mild to moderate cervical spine dysfunction symptoms: a prospective study

“…These results were different from the results of Tsuji et al [ 15 ] study, who found that of Modic changes affected 47 intervertebral disc levels (3.48%) in all 1158 cervical intervertebral levels. The study conducted by Nguyen demonstrated that 58 patients (6.7%) within the 861 patients were found HIZs in their cervical spine [ 16 ]. The patients in our cohort with only mild to moderate cervical spine dysfunction symptoms were the likely cause of this difference.…”

“…Also, Chen et al [12] used the Miyazaki grades to demonstrate that cigarette smoking could accelerate the process of CDD, leading to more severe neckshoulder pain. The relationship between MRI findings on cervical spine and factors influencing CDD has been documented extensively [13][14][15][16][17]. Some studies demonstrated that CDD on MRI was observed in the asymptomatic subjects [18] [1-3] [1-3] [ [1][2][3].…”