Prevalence of High-Intensity Zones in the Lumbar Spine According to Age and Their Correlation with Other Degenerative Findings on Magnetic Resonance Imaging

Abstract

Introduction: A high-intensity zone (HIZ) in an intervertebral disc of the lumbar spine is a high-intensity signal located in the posterior annulus fibrosus on T2-weighted magnetic resonance imaging (MRI). There is limited information on the prevalence of HIZ in the lumbar spine according to age. The aim of this cross-sectional study was to investigate the prevalence of HIZ in the lumbar spine by age and the correlation between HIZ and other degenerative findings, such as disc degeneration, disc bulging and herniation, and changes in adjacent vertebral endplates on lumbar MRI. Methods: We retrospectively reviewed MRI studies of 305 patients (1525 discs) with low back pain, leg pain, or numbness. The prevalence of HIZ was calculated in 5 age groups (<20, 20-39, 40-59, 60-79, 80-91 years). Results: The number of patients in the 5 age groups was 19, 38, 69, 145, and 36, respectively. The prevalence of HIZ in the 5 age groups was 11.8%, 47.3%, 52.2%, 42.8%, and 50.0%, respectively. Disc degeneration was observed in 58.1% and 39.2% of discs with and without HIZ, respectively; disc bulging and herniation was observed in 63.9% and 41.1% and intensity changes at adjacent end plates in 11.6% and 10.0%, respectively. Conclusions: Prevalence of HIZ from the third decade of life onward was around 50%, with no significant change in prevalence beyond the age of 20 years. HIZ was correlated with disc degeneration, disc bulging, and disc herniation in patients with LBP, leg pain, or numbness.

Epidemiology of Lumbar Degenerative Phenotypes of Children and Adolescents: A Large-Scale Imaging Study

“…Series studies revealed that the prevalence of HIZ is not only increasing with aging but also closely relating to disc degeneration and low back pain in adults. 52 , 53 …”

“…Series studies revealed that the prevalence of HIZ is not only increasing with aging but also closely relating to disc degeneration and low back pain in adults. 52,53 Modic changes are a series of degenerative changes involving the vertebral endplates and adjacent vertebral bodies. 11 Modic changes are frequently located adjacent to the degenerated disc and at the 2 lowest levels, 49 implying the potential link between Modic changes and disc degeneration.…”

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

“…Previous studies suggest lumbar HIZs are highly associated with disc degeneration. 6 , 8 , 20 , 22 , 30 The current study analyzed the relationship between cervical HIZs (as well as HIZ subtypes) and other disc pathologies, stratified by concurrence at the same intervertebral level, and by incidence overall from C2-C7. Unexpectedly, cervical HIZs were significantly associated with lower odds of concurrent disc degeneration and disc displacement.…”

Prevalence and association of high-intensity lesions with degenerative processes in lumbar intervertebral discs

“…The correlation between HIZ lesions and clinical symptoms has been the subject to several studies [8][9][10][11][12][13] ; however, research examining the association with other degenerative processes of the spine is limited 14 . MRI-detected HIZ has been reported to be a very effective technique for screening lumbar intervertebral disc degeneration (IDD).…”