Abstract
BackgroundMagnetic resonance imaging (MRI) can provide objective continuous intervertebral disc (IVD) measures in low back pain (LBP) patients. However, there are limited studies comparing quantitative IVD measures of symptomatic and asymptomatic individuals.PurposeThis study aimed to investigate possible differences in IVD tissue composition in patients with chronic LBP and controls using quantitative MRI and correlate IVD measures with the phenotype High-Intensity Zone (HIZ).MethodsThe lumbar spine of 25 LBP-patients (25-69y, mean 38y, 11 males) and 12 controls (25-59y, mean 38y, 7 males) was examined with T2-mapping on a 1.5T MRI scanner. The mean T2-map value and standard deviation were determined in three midsagittal IVD slices and five sub-regions dividing each IVD in the sagittal plane. The distribution of T2-map values over the IVD was also determined with histogram analysis (Δμ = distribution width).ResultsWhen compared to controls, patient IVDs displayed lower values for all metrics, with significant differences for the T2-map value, standard deviation (p = 0.026) and Δμ (p = 0.048). Significantly different T2-map values were found between cohorts in the region representing nucleus pulposus and the border zone between nucleus pulposus and posterior annulus fibrosus (p = 0.047–0.050). Excluding all IVDs with HIZs resulted in no significant difference between the cohorts for any of the analyzed metrics (p = 0.053–0.995). Additionally, the T2-map values were lower in patients with HIZ in comparison without HIZ.ConclusionsDifferences in IVD characteristics, measured with quantitative MRI, between LBP patients and controls were found. The T2-differences may reflect altered IVD function associated with HIZ. Future studies are recommended to explore IVD functionality in relation to HIZ and LBP.
Highlights
Low back pain (LBP) causes more global disability than any other condition [1] and is a welldocumented source of chronic disability for both genders in the working age [2]
This study aimed to investigate possible differences in Intervertebral disc (IVD) tissue composition in patients with chronic LBP and controls using quantitative Magnetic resonance imaging (MRI) and correlate IVD measures with the phenotype High-Intensity Zone (HIZ)
Excluding all IVDs with HIZs resulted in no significant difference between the cohorts for any of the analyzed metrics (p = 0.053–0.995)
Summary
Low back pain (LBP) causes more global disability than any other condition [1] and is a welldocumented source of chronic disability for both genders in the working age [2]. IVD degeneration is common among asymptomatic individuals [5] and this limits the clinical relevance of IVD degeneration used for targeting the source of LBP. Research has aimed to establish the relationship between IVD degeneration and LBP through gross morphological IVD measures. Modic changes [6] as well as the presence of High-Intensity Zones (HIZs) [7] have been pointed out as specific degenerative markers in the spine and may, as such, be associated with new specific IVD metrics. Magnetic resonance imaging (MRI) can provide objective continuous intervertebral disc (IVD) measures in low back pain (LBP) patients. There are limited studies comparing quantitative IVD measures of symptomatic and asymptomatic individuals. This study aimed to investigate possible differences in IVD tissue composition in patients with chronic LBP and controls using quantitative MRI and correlate IVD measures with the phenotype High-Intensity Zone (HIZ)
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