Abstract
BackgroundThis meta-analysis aimed to assess the correlation between the high-intensity zone (HIZ) of a lumbar MRI and discography.MethodsWe conducted an electronic search of the PubMed, MEDLINE, Embase, and ScienceDirect databases from their respective inceptions to October 2016 using the following search terms: “low back pain,” “discogenic low back pain,” “HIZ or high-intensity zone,” and “discography”. Relevant journals and conference proceedings were manually searched. Two reviewers independently assessed the quality of the studies, extracted data from the included studies, and analyzed the data.ResultsEleven studies were included. The results of the meta-analysis indicated that outstanding relativity and statistically significant correlations were observed between the HIZ and abnormal disc morphology (OR = 47.79; 95% CI: 17.07 to 133.77; P < 0.00001), HIZ and pain reproduction (OR = 8.65, 95% CI: 6.01 to 15.23, P < 0.00001), and HIZ and abnormal morphology pain reproduction (OR = 11.74, 95% CI: 1.99 to 69.36, P = 0.007).ConclusionsThe presence of an HIZ on a lumbar MRI T2-weighted image indicates abnormal disc morphology. There is a strong relationship between the HIZ and pain reproduction. The HIZ can be an effective index for prediction of discogenic low back pain.
Highlights
This meta-analysis aimed to assess the correlation between the high-intensity zone (HIZ) of a lumbar magnetic resonance imaging (MRI) and discography
Inclusion criteria This review was conducted in accordance with guidelines described in the Cochrane handbook for systematic review and meta-analysis of interventions [12] and met the criteria of the Meta-analysis of Observational Studies in Epidemiology (MOOSE) [13]
The most important finding of the present study was that the HIZ on a lumbar MRI T2-weighted image was associated with abnormal disc morphology in the discography
Summary
This meta-analysis aimed to assess the correlation between the high-intensity zone (HIZ) of a lumbar MRI and discography. The incidence of LBP has gradually increased, and provocative discography is considered the gold standard for diagnosing LBP [2]. Provocative discography is invasive and associated with complications, including neurological injury, infection, or contrast medium reaction [3]. In 1992, Aprill and Bogduk [4] first described a highintensity zone (HIZ) on magnetic resonance imaging (MRI) located in the posterior annulus fibrosus that was clearly separated from the nucleus pulposus. The subsequent literature has reported consistent results [7, 8]; several studies have shown a limited role of the HIZ in diagnosing LBP [9,10,11]. The correlation between HIZ-positive discs and exact or
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