| Clinical Significance of the Anatomical Abnormal Findings on Lumbar MRI in Patients with Chronic Low Back Pain |
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Jowa Hyuk Ihm, M.D., Jong Hun Lee, M.D.1, Jin Sik Noh, M.D. and Choong Bae Moon, M.D. |
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Department of Neurosurgery and Radiology1, Sarang Hospital, Pohang, Korea |
| 만성요통 환자의 자기공명영상에서 관찰되는 해부학적 이상 소견의 임상적 의의 |
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임좌혁·이종훈1·노진식1·문충배 |
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포항 사랑병원 신경외과, 방사선과1 |
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| Abstract |
Objective
The authors have carried research on patients with chronic low back pain in order to investigate the predictive value of magnetic resonance imaging(MRI) of pathoanatomical abnormalities of the intervertebral discs, particularly with adjacent endplate(Modic) change, high-intensity zone(HIZ) and disc degeneration, to predict symptomatic disc derangement, with disco- graphy as the standard.
Methods
The authors prospectively analyzed the discographic findings and anatomical abnormalities on lumbar spine MRI in 187 patients with chronic low back pain. MR images were evaluated for disc degeneration, high-intensity zone, and endplate abnormalities. Results of pain provocation at discography(527 discs) were rated independently of the image findings as concordant or as discordant or painless. Sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) were calculated to assess the clinical relevance of abnormalities on MRI.
Results
The prevalence of a high-intensity zone in the patients was 53.5%. Significant correlation was found between abnor- mal disc morphology and the HIZ(p<0.05). In morphologically abnormal discs(grade 3,4), there was a significant correlation between the HIZ and concordant pain reproduction(p<0.001). For concordant pain production, high-intensity zone(sensitivity, 41%; specificity, 78.6%; PPV, 26.4%; NPV, 87.7%), abnormal discogram(sensitivity, 94%; specificity, 77.5%; PPV, 18.5%; NPV, 95.2%), disc degeneration(sensitivity, 85.5%; specificity, 73.4%; PPV, 17.9%; NPV, 90.8%), and Modic change(sensitivity, 3.6%; specificity, 4.5%; PPV, 13.1%; NPV, 84.7%) were not helpful in identification of the symptomatic disc derangement.
Conclusion
We conclude from our prospective study that the 3 pathoanatomical parameters(disc degeneration, HIZ, Modic change) observed on MRI appear not to be useful in the prediction of painful disc derangement in patients with chronic low back pain.
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| Keywords:
Provocative discography, High-intensity zone, Disc degeneration, Vertebral endplate(Modic) change |
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