Abstract
Low back pain (LBP) is a common affliction with numerous causes. Some individuals experience LBP attributed to disc pathology. Disc pathology has been implicated in a plurality of cases of LBP, and some cases are associated with annular fissures (AFs). AFs are weaknesses in the structure that contains the nucleus pulposus and is the site of possible disc herniations. On magnetic resonance imaging (MRI), some AFs manifest as the high-intensity zone (HIZ), otherwise known as an annular enhancement region. In this report, we present three patients with LBP, mild radiculitis, and HIZ who later developed herniated nucleus pulposus (HNP) with extrusion through the HIZ. These cases suggest that HIZ indicates a propensity for the future development of disc extrusion through the weakened tissue at the AF visualized as HIZ on MRI. With a better understanding of the association between AFs and disc herniations with HIZ, clinicians may be able to predict and prevent the pain and disability associated with disc extrusion.
Highlights
Low back pain (LBP) is a common medical issue with a variety of underlying causes [1]
Disc pathology has been implicated in a plurality of cases of LBP, and some cases are associated with annular fissures (AFs)
We present three patients with LBP, mild radiculitis, and high-intensity zone (HIZ) who later developed herniated nucleus pulposus (HNP) with extrusion through the HIZ
Summary
Low back pain (LBP) is a common medical issue with a variety of underlying causes [1]. MRI demonstrated right L5-S1 subarticular disc extrusion from the location of the HIZ with compression of the right traversing S1 nerve root (Figure 1B) Her radicular symptoms in the back and buttock remitted after several months of physical therapy and antiinflammatories. In 2018, he presented to the clinic with acute exacerbation of LBP and was found to have an HIZ in proximity to the left S1 nerve root at the L5-S1 disc (Figure 2A), which was treated with physical therapy and epidural steroid injections. MRI demonstrated disc extrusion at L5-S1 from the location of the HIZ impinging on the left traversing S1 nerve root (Figure 2B) His radicular symptoms remitted after several months of physical therapy, antiinflammatories, and epidural steroid injections. Patient (Case 3) with magnetic resonance imaging revealing high-intensity zones (2A) indicated by the small arrowhead correlating to areas of disc extrusion (2B) indicated by the arrow
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