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HIZ’s relation to axial load and low back pain: investigated with axial loaded MRI and pressure controlled discography

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An Erratum to this article was published on 21 November 2012

Abstract

Purpose

The aims were to investigate if the detection of high-intensity zones (HIZ) is affected by axial load, and to study the correlation between HIZ and discogenic pain provoked with pressure controlled discography (PCD).

Methods

41 consecutive patients with chronic low back pain, referred for discography, were included. Each patient underwent PCD, CT, MRI, and axial loaded MRI (alMRI) within 24 h. 35 patients completed all MRI sequences (140 discs). The detection of HIZ was compared between conventional MRI and alMRI. PCD was performed in 119 of the discs examined at MRI. Provoked pain at PCD was classified into four categories (none/unfamiliar/similar/exact), with the patients’ daily pain as reference, and correlated with presence of HIZ.

Results

AlMRI did not affect the detection of HIZ compared with conventional MRI. No significant correlation between HIZ and the 4-graded pain response at discography was found (p = 0.34), neither when combining similarly/exactly reproduced pain (p = 0.08). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of HIZ in detecting discs with exactly reproduced pain were 49, 69, 39 and 76 %. When combining similarly/exactly reproduced pain, PPV was higher but still only 70 %.

Conclusions

The detection of HIZ was not influenced by axial load. With strict PCD, discogenic pain can neither be confirmed when having HIZ (PPV 39 %) nor ruled out in discs without HIZ (NPV 76 %). Larger PCD studies including quantification of HIZ at conventional and alMRI are needed, before any dynamic component affected by axial load can be ruled out completely.

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Acknowledgments

The study was supported by funds from University of Gothenburg (ALF) and Gothenburg Medical Society.

Conflict of interest

None.

Ethical standard

Ethical approval was granted by the Ethics Committee of Gothenburg, Sweden.

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Authors and Affiliations

  1. Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden

    Hebelka Hanna

  2. Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden

    Hansson Tommy

  3. Barnröntgen, Drottning Silvias Barn och Ungdomssjukhus, Smörslottsgatan 1, 416 85, Gothenburg, Sweden

    Hebelka Hanna

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  1. Hebelka Hanna
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Correspondence to Hebelka Hanna.

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Hanna, H., Tommy, H. HIZ’s relation to axial load and low back pain: investigated with axial loaded MRI and pressure controlled discography. Eur Spine J 22, 734–739 (2013). https://doi.org/10.1007/s00586-012-2501-y

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  • DOI: https://doi.org/10.1007/s00586-012-2501-y

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