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Lumbar Annular High-Intensity Zone as a Precursor to Disc Extrusion
Deion L Ellis1, Reza Ehsanian1, Peter C Shin2
1Physical Medicine & Rehabilitation, University of New Mexico School of Medicine, Albuquerque, USA.
Cureus
|January 7, 2022
Summary
Low back pain linked to disc issues may be predicted by the high-intensity zone (HIZ) on MRI. This finding suggests HIZ indicates future disc extrusion, potentially preventing pain.
Area of Science:
- Orthopedics
- Radiology
- Pain Management
Background:
- Low back pain (LBP) is a prevalent condition with diverse etiologies.
- Disc pathology is a significant contributor to LBP.
- Annular fissures (AFs) are implicated in some LBP cases, representing weaknesses in the disc annulus.
Observation:
- Annular fissures (AFs) can manifest as a high-intensity zone (HIZ) on magnetic resonance imaging (MRI).
- HIZ is also referred to as an annular enhancement region.
- Three patients with LBP, mild radiculitis, and HIZ subsequently developed herniated nucleus pulposus (HNP) with extrusion through the HIZ.
Findings:
- The presence of HIZ on MRI may indicate a predisposition for future disc extrusion.
- Disc herniation can occur through the weakened annular tissue visualized as HIZ.
- This association highlights the prognostic value of HIZ in disc pathology.
Implications:
- Understanding the link between AFs, HIZ, and disc herniation can aid in predicting outcomes.
- Early identification of HIZ may allow for proactive management strategies.
- This knowledge could help clinicians prevent or mitigate the pain and disability associated with disc extrusion.
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