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Chiropractic Research Review

High-Intensity-Zones and Low Back Pain

A strong correlation between anular high-intensity zones (HIZ) on lumbar magnetic resonance imaging (MRI) and the results of provocative discography in patients with low back pain (LBP) has been reported.

It also has been suggested that the presence of a high-intensity zone could indicate LBP, caused by the disc with that anular finding. To investigate this theory, a group of asymptomatic patients with known risk factors for lumbar disc degeneration was compared with a symptomatic group of patients with respect to the presence of anular HIZ and pain response.

In this study, patients with LBP and those without LBP underwent physical examination, psychometric testing, plain radiograph, MRI, and discography. The presence of HIZ, anular disruption, and positive discographic pain was compared between the two groups using standardized criteria on T2-weighted MRIs.

The authors observed that the ability to diagnose the cause of LBP reliably by noninvasive methods has proven elusive. To this end, the authors offer the following in their conclusion:

* Fifty-nine percent of patients receiving discography were found to have lumbar HIZ, compared to 25% of asymptomatic subjects of a similar patient profile.
* Approximately 70% of patients had significant pain with discographic injection, whether they were symptomatic or not.
* Both symptomatic and asymptomatic groups demonstrated that abnormal psychometric testing and chronic pain issues predicted increased pain on injection of HIZ discs.
* The theory that HIZ observed on lumbar MRI is a reliable indicator of symptomatic internal disc disruption is not supported by this study.

Carragee EJ, Paragioudakis SJ, Khurana S. Lumbar high-intensity zone and discography in subjects without lower back problems. Spine 2000:25(23), pp 2987-2992.

Chiropractic Research Review

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