Lomber intervertebral disklerdeki yüksek yoğunluklu lezyonların prevalansı ve dejeneratif süreçlerle ilişkisi

Year 2024, Volume: 49 Issue: 1, 113 - 120, 29.03.2024

Zafer Soydan Emru Bayramoğlu

https://doi.org/10.17826/cumj.1415779

Abstract

Amaç: Bu toplum tabanlı kesitsel çalışmanın amacı lomber omurgada yüksek yoğunluklu bölgelerin (YYA) yaygınlığını incelemek ve YYA ile yaş, cinsiyet ve disk dejenerasyonu, disk yer değiştirmesi (bulging veya herniasyon) ve faset eklem dejenerasyonu gibi diğer dejeneratif süreçler arasındaki korelatif ilişkileri araştırmaktır.
Gereç ve Yöntem: Subakut-kronik bel ağrısı (LBP) ile hastaneye başvuran ve polikliniklerde aksiyel yayılan (muskulojenik-diskojenik-mekanik) ağrısı olan 800 hastanın (4000 disk) MRG çalışmaları üzerinde retrospektif bir analiz yapıldı. YYA sıklığı, on yıllar içinde toplam yedi dekad içinde dikkate alınarak belirlendi. YYA ile diğer değişkenler arasında korelasyon analizleri yapıld.
Bulgular: YYA prevalansı %30 olup, >70 yaş grubunda en yüksek ve <20 yaş grubunda en düşüktür. Bu lezyonlar ile L2-3-4-5 seviyesinde disk dejenerasyonu, L3-L4 seviyesinde disk deplasmanı ve L1-2-3 seviyesinde faset eklem dejenerasyonu arasında anlamlı korelasyonlar bulunmuştur. YYA ile yaş arasında anlamlı bir korelasyon vardı, ancak cinsiyet ile yoktu. Bu lezyonlar en sık Evre 3 disk dejenerasyonu ile ilişkiliydi.
Sonuç: YYA muhtemelen diskojenik LBP gelişimine katkıda bulunmaktadır. YYA prevalansı yaşa bağlı önemli farklılıklar göstermekle birlikte yaklaşık %30'dur. LBP'li hastalarda YYA ile disk dejenerasyonu, disk deplasmanı ve faset eklem dejenerasyonu arasında seviyeye dayalı bir ilişki olduğu ortaya çıkarılmıştır.

Keywords

Yüksek yoğunluk alanları, YYA, disk dejenerasyonu, disk bulging, disk herniasyonu, faset eklem dejenerasyonu, MRG.

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

Abstract

Purpose: This population-based cross-sectional study examined the prevalence of high-intensity zones (HIZ) in the lumbar spine and their relationship to age, gender, disc degeneration, disc displacement (bulging or herniation), and facet joint degeneration.
Materials and Methods: A retrospective analysis was conducted on MRI studies of 800 patients (4000 discs) who were admitted to the hospital with subacute-chronic low back pain (LBP) and presented with axial pain (musculogenic-discogenic-mechanic) at outpatient clinics. The frequency of speed was determined by considering a total of seven age categories in decades. Correlation analyses were performed between HIZ and other variables.
Results: The prevalence of HIZ was 30%, highest in the >70 years age group and lowest in the <20 years age group. Significant correlations were found between these lesions and L2-3-4-5 level disc degeneration, L3-L4 level disc displacement, and L1-2-3 level facet joint degeneration. There was a significant correlation between HIZ and age, but not with gender. These lesions were most commonly associated with Grade 3 disc degeneration.
Conclusions: HIZ likely contributes to the development of discogenic LBP. The prevalence of HIZ was approximately 30%, with substantial age-related variations. A level-based association was observed between HIZ and disc degeneration, disc displacement, and facet joint degeneration in patients with LBP.

Keywords

High-intensity zones, HIZ, Disc degeneration, Disc bulging, Disc herniation, Facet Joint degeneration, MRI

References

• Aprill C, Bogduk N. High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging. Br J Radiol. 1992;65:361-9.
• Yu SW, Sether LA, Ho PS, Wagner M, Haughton VM. Tears of the anulus fibrosus: correlation between mr and pathologic findings in cadavers. AJNR Am J Neuroradiol. 1988;9:367-70.
• Dongfeng R, Hou S, Wu W, Wang H, Shang W, Tang J et al. The expression of tumor necrosis factor-α and CD68 in high-intensity zone of lumbar intervertebral disc on magnetic resonance image in the patients with low back pain. Spine (Phila Pa 1976). 2011;36:429-33.
• Latka K, Kozlowska K, Waligora M, Kolodziej W, Latka D. Effect of discogel treatment of the intervertebral disc at mri. Clin Radiol. 2023;78:928-34.
• Wang ZX, Hu YG. Factors associated with lumbar disc high-intensity zone (hiz) on t2-weighted magnetic resonance image: a retrospective study of 3185 discs in 637 patients. J Orthop Surg Res. 2018;13:307.
• Chen ZY, Ma L, Li T. Imaging of low back pain: comparative role of high intensity zone in diagnosing the discogenic low back pain with evidence-based radiology. Chin Med J (Engl). 2009;122:3062-5.
• Böhm B, Meinig H, Eckardt A, Schadmand-Fischer S, Heine J. Korrelation degenerativer bandscheibenveränderungen im mrt mit dem befund der diskographie bei rückenschmerzpatienten [correlation of degenerative intervertebral disk displacement using mri with discography findings in patients with back pain]. Orthopade. 2005;34:1144-9. German.
• Carragee EJ, Paragioudakis SJ, Khurana S. 2000 Volvo Award winner in clinical studies: lumbar high-intensity zone and discography in subjects without low back problems. Spine (Phila Pa 1976). 2000;25:2987-92.
• Jha SC, Takata Y, Abe M, Yamashita K, Tezuka F, Sakai T et al. High intensity zone in lumbar spine and its correlation with disc degeneration. J Med Invest. 2017;64:39-42.
• Adams MA, Roughley PJ. What is intervertebral disc degeneration, and what causes it? Spine (Phila Pa 1976). 2006;31:2151-61.
• Cheung JPY, Luk KDK. The relevance of high-intensity zones in degenerative disc disease. Int Orthop. 2019;43:861-7.
• Zehra U, Ilyas MS, Latif R, Imran S, Ahmad I, Aziz A. MRI phenotypes of herniated discs associated with adjacent disc degeneration. J Orthop Res. 2023. doi: 10.1002/jor.25739.
• Takeuchi M, Nagamachi A, Adachi K, Inoue K, Tamaki Y, Omichi Y et al Prevalence of high-intensity zones in the lumbar spine according to age and their correlation with other degenerative findings on magnetic resonance imaging. Spine Surg Relat Res. 2018;2:299-303.
• Chen X, Tamai K, Yang JJ, Shah ID, Paholpak P, Wang JC et al. Impact of high-intensity zones on their corresponding lumbar spine segments: a propensity score-matched analysis. Clin Spine Surg. 2021;34:32-8.
• Wang ZX, Hu YG. Imaging analysis of the high-intensity zone on lumbar spine magnetic resonance images: classification, features and correlation with low back pain. J Pain Res. 2021;14:2981-9.
• Wang ZX, Hou ZT, Hu YG. Anterior high-intensity zone in lumbar discs: prevalence and association with low back pain. Pain Med. 2020;21:2111-6.
• Teraguchi M, Samartzis D, Hashizume H, Yamada H, Muraki S, Oka H, et al. Classification of high intensity zones of the lumbar spine and their association with other spinal mri phenotypes: the wakayama spine study. PLoS One. 2016;11:e0160111.
• Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J. 2014;14:2525-45.
• Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001;26:1873-8.
• Weishaupt D, Zanetti M, Boos N, Hodler J. Mr imaging and ct in osteoarthritis of the lumbar facet joints. Skeletal Radiol. 1999;28:215-9.
• Kobayashi K, Otani K, Sekiguchi M, Kato K, Tominaga R, Konno SI. Relationship between lumbar facet joint osteoarthritis and comorbidities: a cross-sectional study in the Japanese community. J Orthop Sci. 2023;S0949-2658.
• Akoglu H. User's guide to correlation coefficients. Turk J Emerg Med. 2018;18:91-3.
• Schellhas KP, Pollei SR, Gundry CR, Heithoff KB. Lumbar disc high-intensity zone. correlation of magnetic resonance imaging and discography. Spine (Phila Pa 1976). 1996;21:79-86.
• Ellis DL, Ehsanian R, Shin PC, Rivers WE. Lumbar annular high-intensity zone as a precursor to disc extrusion. Cureus. 2021;13:e20111.
• Takatalo J, Karppinen J, Niinimäki J, Taimela S, Mutanen P, Sequeiros RB et al. Association of modic changes, schmorl's nodes, spondylolytic defects, high-intensity zone lesions, disc herniations, and radial tears with low back symptom severity among young Finnish adults. Spine (Phila Pa 1976). 2012;37:1231-9.
• Bartynski WS, Agarwal V, Trang H, Bandos AI, Rothfus WE, Tsay J et al. Enhancing annular fissures and high-intensity zones: pain, internal derangement, and anesthetic response at provocation lumbar discography. AJNR Am J Neuroradiol. 2023;44:95-104.
• Dutta S, Bhave A, Patil S. Correlation of 1.5 tesla magnetic resonance imaging with clinical and intraoperative findings for lumbar disc herniation. Asian Spine J. 2016;10:1115-21.
• Wang HQ, Samartzis D. Clarifying the nomenclature of intervertebral disc degeneration and displacement: from bench to bedside. Int J Clin Exp Pathol. 2014;7:1293-8.
• Kleinstück F, Dvorak J, Mannion AF. Are "structural abnormalities" on magnetic resonance imaging a contraindication to the successful conservative treatment of chronic nonspecific low back pain? Spine (Phila Pa 1976). 2006;31:2250-7.
• Kasch R, Truthmann J, Hancock MJ, Maher CG, Otto M, Nell C et al. Association of lumbar mri findings with current and future back pain in a population-based cohort study. Spine (Phila Pa 1976). 2022;47:201-11.
• Wilkens P, Scheel IB, Grundnes O, Hellum C, Storheim K. Prognostic factors of prolonged disability in patients with chronic low back pain and lumbar degeneration in primary care: a cohort study. Spine (Phila Pa 1976). 2013;38:65-74.
• Hellum C, Johnsen LG, Gjertsen Ø, Berg L, Neckelmann G, Grundnes O et al. Predictors of outcome after surgery with disc prosthesis and rehabilitation in patients with chronic low back pain and degenerative disc: 2-year follow-up. Eur Spine J. 2012;21:681-90.