The Value of Lumbar Spine Magnetic Resonance Imaging in the Demonstration of Anular Tears

Saifuddin, Asif; Braithwaite, Ian; White, James; Taylor, Ben; Renton, P.

doi:10.1097/00007632-199802150-00009

Cited by 133 publications

(63 citation statements)

References 16 publications

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“…Significant association between HIZ and discogenic pain was not found in contrary to many previous studies [1,6,9,10,15,26]. Granulation tissue is likely to change over time rendering this study an edge, since MRI and discography were performed within 24 h. The time interval between the two procedures varied between 4 weeks [5] and 5 months [13] in the previous studies correlating HIZ and discography findings, and could be a possible explanation of the discrepancy with this study.…”

Section: Discussioncontrasting

confidence: 90%

“…Granulation tissue is likely to change over time rendering this study an edge, since MRI and discography were performed within 24 h. The time interval between the two procedures varied between 4 weeks [5] and 5 months [13] in the previous studies correlating HIZ and discography findings, and could be a possible explanation of the discrepancy with this study. The PPV of HIZ in terms of exactly reproduced pain was only 39 % compared to, between 83 and 95 % [1,6,[9][10][11] in studies favoring HIZ as a reliable marker of discogenic pain. Among numerous authors correlating HIZ and discogenic pain [1, 2, 4-13, 15, 26], only Carragee et al [5] and O'Neill et al [8] used PCD.…”

Section: Discussionmentioning

confidence: 99%

“…However, the diagnostic role of HIZ is limited due to low sensitivity [4][5][6][7][8]. The importance of HIZ in discogenic low back pain (LBP) remains therefore unclear.…”

Section: Introductionmentioning

confidence: 99%

“…The importance of HIZ in discogenic low back pain (LBP) remains therefore unclear. Pressure controlled discography (PCD), now criterion standard, has not been used in the majority of the numerous studies correlating HIZ and discogenic pain [1][2][3][4][5][6][7][9][10][11][12][13][14][15][16] making previous results dubiousm, since discography without pressure registration can induce false positive responses [17,18].…”

Section: Introductionmentioning

confidence: 99%

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HIZ’s relation to axial load and low back pain: investigated with axial loaded MRI and pressure controlled discography

Hebelka

Hansson

2012

Eur Spine J

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Purpose The aims were to investigate if the detection of high-intensity zones (HIZ) is affected by axial load, and to study the correlation between HIZ and discogenic pain provoked with pressure controlled discography (PCD). Methods 41 consecutive patients with chronic low back pain, referred for discography, were included. Each patient underwent PCD, CT, MRI, and axial loaded MRI (alMRI) within 24 h. 35 patients completed all MRI sequences (140 discs). The detection of HIZ was compared between conventional MRI and alMRI. PCD was performed in 119 of the discs examined at MRI. Provoked pain at PCD was classified into four categories (none/unfamiliar/similar/ exact), with the patients' daily pain as reference, and correlated with presence of HIZ. Results AlMRI did not affect the detection of HIZ compared with conventional MRI. No significant correlation between HIZ and the 4-graded pain response at discography was found (p = 0.34), neither when combining similarly/exactly reproduced pain (p = 0.08). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of HIZ in detecting discs with exactly reproduced pain were 49, 69, 39 and 76 %. When combining similarly/exactly reproduced pain, PPV was higher but still only 70 %. Conclusions The detection of HIZ was not influenced by axial load. With strict PCD, discogenic pain can neither be confirmed when having HIZ (PPV 39 %) nor ruled out in discs without HIZ (NPV 76 %). Larger PCD studies including quantification of HIZ at conventional and alMRI are needed, before any dynamic component affected by axial load can be ruled out completely.

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Section: Discussioncontrasting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

“…However, the diagnostic role of HIZ is limited due to low sensitivity [4][5][6][7][8]. The importance of HIZ in discogenic low back pain (LBP) remains therefore unclear.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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HIZ’s relation to axial load and low back pain: investigated with axial loaded MRI and pressure controlled discography

Hebelka

Hansson

2012

Eur Spine J

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“…They believed that the HIZ in patients with low back pain is likely to represent painful internal disc disruption. Saifuddin et al [15] found that the clinical significance of the HIZ was limited as its sensitivity was as low as 26.7%. Ricketson et al [12] found no correlation between the presence of an HIZ and discographically identified annular tears.…”

Section: Discussionmentioning

confidence: 99%

The pathogenesis and clinical significance of a high-intensity zone (HIZ) of lumbar intervertebral disc on MR imaging in the patient with discogenic low back pain

et al. 2005

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Prediction of the biomechanical behaviour of the lumbar spine under multi‐axis whole‐body vibration using a whole‐body finite element model

Zhang

Guo

2023

Numer Methods Biomed Eng

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Low back pain has been reported to have a high prevalence among occupational drivers. Whole‐body vibration during the driving environment has been found to be a possible factor leading to low back pain. Vibration loads might lead to degeneration and herniation of the intervertebral disc, which would increase incidence of low back problems among drivers. Some previous studies have reported the effects of whole‐body vibration on the human body, but studies on the internal dynamic responses of the lumbar spine under multi‐axis vibration are limited. In this study, the internal biomechanical response of the intervertebral disc was extracted to investigate the biomechanical behaviour of the lumbar spine under a multi‐axial vibration in a whole‐body environment. A whole‐body finite element model, including skin, soft tissues, the bone skeleton, internal organs and a detailed ligamentous lumbar spine, was used to provide a whole‐body condition for analyses. The results showed that both vibrations close to vertical and fore‐and‐aft resonance frequencies would increase the transmission of vibrations in the intervertebral disc, and vertical vibration might have a greater effect on the lumbar spine than fore‐and‐aft vibration. The larger deformation of the posterior region of the intervertebral disc in a multi‐axis vibration environment might contribute to the higher susceptibility of the posterior region of the intervertebral disc to injury. The findings of this study revealed the dynamic behaviours of the lumbar spine in multi‐axis vehicle vibration conditions, and suggested that both vertical and fore‐and‐aft vibration should be considered for protecting the lumbar health of occupational drivers.

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The Value of Lumbar Spine Magnetic Resonance Imaging in the Demonstration of Anular Tears

Abstract: These results confirm that the high-intensity zone is a marker of a painful posterior anular tear. However, the usefulness of this sign is limited by low sensitivity.

Cited by 133 publications

References 16 publications

HIZ’s relation to axial load and low back pain: investigated with axial loaded MRI and pressure controlled discography

HIZ’s relation to axial load and low back pain: investigated with axial loaded MRI and pressure controlled discography

The pathogenesis and clinical significance of a high-intensity zone (HIZ) of lumbar intervertebral disc on MR imaging in the patient with discogenic low back pain

Prediction of the biomechanical behaviour of the lumbar spine under multi‐axis whole‐body vibration using a whole‐body finite element model

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