University of Oulu

Masatoshi Teraguchi, Jason P.Y. Cheung, Jaro Karppinen, Cora Bow, Hiroshi Hashizume, Keith D.K. Luk, Kenneth M.C. Cheung, Dino Samartzis, Lumbar high-intensity zones on MRI: imaging biomarkers for severe, prolonged low back pain and sciatica in a population-based cohort, The Spine Journal, Volume 20, Issue 7, 2020, Pages 1025-1034, ISSN 1529-9430,

Lumbar high-intensity zones on MRI : imaging biomarkers for severe, prolonged low back pain and sciatica in a population-based cohort

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Author: Teraguchi, Masatoshi1,2,3; Cheung, Jason P. Y.1; Karppinen, Jaro4,5;
Organizations: 1Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China
2Spine Care Center, Wakayama Medical University, Kihoku Hospital, Ito, Wakayama, Japan
3Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
4Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
5Finnish Institute of Occupational Health, Oulu, Finland
6Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
7International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
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Language: English
Published: Elsevier, 2020
Publish Date: 2020-11-02


Background context: There is often discrepancy between clinical presentation and lumbar magnetic resonance imaging (MRI) findings.

Purpose: The purpose of this study was to assess the relationship of high-intensity zones (HIZs) on MRI with low back pain (LBP), sciatica, and back-related disability.

Study design: Cross-sectional, population-based Southern Chinese cohort study.

Patient sample: Of 1,414 possible participants, data from 1,214 participants (453 males, 761 females; mean age of 48.1±6.3 years) were included.

Outcome measures: Presence of single-level, homogeneous multilevel (same type HIZs of morphology and topography) and heterogeneous multilevel (mixed type HIZs of morphology and topography) HIZs and other MRI phenotypes were assessed at each level with T2-weighted 3T sagittal MRI of L1–S1. Associations with LBP, sciatica and Oswestry Disability Index were correlated with HIZ profiles.

Results: In all, 718 individuals had HIZs (59.1%). Disc degeneration/displacement were more prevalent in HIZ individuals (p<.001). HIZ subjects experienced prolonged severe LBP more frequently (39.6% vs. 32.5%; p<.05) and had higher Oswestry Disability Index scores (10.7±13.7 vs. 8.9±11.3; p<.05). Posterior multilevel HIZ were significantly associated with prolonged severe LBP (OR: 2.18; 95% CI:1.42–3.37; p<.05) in comparison to anterior only, anterior/posterior or other patterns of HIZ. Multilevel homogeneous or heterogeneous HIZs were significantly associated with prolonged, severe LBP (OR: 1.53–1.57; p<.05). Individuals with homogeneous HIZs had a higher risk of sciatica (OR: 1.51, 95% CI: 1.01–2.27; p<.05).

Conclusions: This is the first large-scale study to note that lumbar HIZs, and specific patterns therein, are potentially clinically-relevant imaging biomarkers that are independently and significantly associated with prolonged/severe LBP and sciatica. HIZs, especially homogenous multilevel HIZ, should be noted in the global pain imaging phenotype assessment.

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Series: Spine journal
ISSN: 1529-9430
ISSN-E: 1878-1632
ISSN-L: 1529-9430
Volume: 20
Issue: 7
Pages: 1025 - 1034
DOI: 10.1016/j.spinee.2020.02.015
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: This work was supported by grants from the Hong Kong Theme-Based Research Scheme (T12-708/12N), Hong Kong Area of Excellence programme (AoE/M-04/04), Hong Kong Research Grants Council (17117814), and the International Society for the Study of the Lumbar Spine MacNab/LaRocca Award. The corresponding author was supported by grant from Grant-in-Aid for Scientific Research (C 26861206).
Copyright information: © 2020 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license.(