Lumbar disc high-intensity zone: the value and significance of provocative discography in the determination of the discogenic pain source
Lumbar disc high-intensity zone: the value and significance of provocative discography in the determination of the discogenic pain source
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DOI：
10.1007/s005860050006
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发表时间：
2000-02-01
影响因子：
2.8
通讯作者：
Mulholland, RC
中科院分区：
文献类型：
--
作者：
Lam, KS;Carlin, D;Mulholland, RC
关于磁共振成像（MRI）显示的高强度区（HIZ）作为腰痛患者潜在疼痛指标的意义，文献中仍存在分歧。因此，我们进行了一项前瞻性盲法研究，通过腰椎间盘造影术的疼痛激发反应来评估腰椎间盘高强度区。对保守治疗无反应且考虑进行脊柱融合的连续腰痛患者接受MRI检查，然后进行腰椎间盘造影术作为术前评估。造影师对核磁共振扫描的结果一无所知。我们用卡方检验来分析我们的结果。73例患者中发现92例HIZs，主要发生在L4/5（48%）和L5/S1（35%）。椎间盘形态异常与HIZ有显著相关性（P < 0.001）。在形态异常的椎间盘（3级、4级和5级）中，HIZ与确切或相似的疼痛再现之间存在显著关联（P < 0.001）。对疼痛生殖的敏感性、特异性和阳性预测值较高，为81%。分别为79%和87%。HIZ的性质尚不清楚，但它可能是由于环撕裂引起的继发性炎症。我们从我们的研究中得出结论，腰痛患者在MRI上观察到的腰椎间盘HIZ可能代表疼痛的内椎间盘断裂。
Disagreement still exists in the literature as to the significance of the high-intensity zone (HIZ) demonstrated on magnetic resonance imaging (MRI) as a potential pain indicator in patients with low back pain. A prospective blind study was therefore conducted to evaluate the lumbar disc high-intensity zone with the pain provocation response of lumbar discography. Consecutive patients with low back pain unresponsive to conservative treatment and being considered for spinal Fusion were subjected to MRI followed by lumbar discography as a pre-operative assessment. The discographer was blinded to the results of the MRI scans. We used the chi-squared test to analyse our results. Ninety-two HIZs were identified in 73 patients, mainly occurring at L4/5 (48%) and L5/S1 (35%). Significant correlation was found between abnormal disc morphology and the HIZ (P < 0.001). In morphologically abnormal discs (grades 3, 4 and 5), there was a significant con elation between the HIZ and exact or similar pain reproduction (P < 0.001). The sensitivity, specificity and positive predictive value for pain reproduction were high, at 81%. 79% and 87% respectively. The nature of the HIZ remains unknown, but it may represent an area of secondary inflammation as a result of an annular tear. We conclude from our study that the lumbar disc HIZ observed on MRI in patients with low back pain is likely to represent painful internal disc disruption.