Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/61162
Citations
Scopus Web of Science® Altmetric
?
?
Type: Journal article
Title: Are high-intensity zones and Modic changes mutually exclusive in symptomatic lumbar degenerative discs?
Author: Marshman, L.
Metcalfe, A.
Krishna, M.
Friesem, T.
Citation: Journal of Neurosurgery: Spine, 2010; 12(4):351-356
Publisher: American Association of Neurological Surgeons
Issue Date: 2010
ISSN: 1547-5654
1547-5646
Statement of
Responsibility: 
Laurence A.G. Marshman, Andrew V. Metcalfe, Manoj Krishna, and Tai Friesem
Abstract: Object: Modic changes (MCs) and high-intensity zones (HIZs) potentially serve as variably sensitive markers for discogenic chronic low-back pain (CLBP). No study has hitherto assessed the phenomenon of MC-HIZ coexistence at a single level, and the goal in this study was to assess the nature and frequency of this phenomenon. Methods: One hundred twenty consecutive patients with discogenic CLBP in whom lumbar MR imaging studies had demonstrated an HIZ, an MC, or both were included. Results: This cohort (120 consecutive patients with 193 degenerative discs) had discogenic CLBP in at least 1 lumbar level associated with either an HIZ (77 discs), an MC (67 discs), or both (16 patients); there were 55 coexistent non-HIZ/non-MC degenerative discs. Painful MC-HIZ coexistence at 1 level occurred in 6 patients (5 of whom were female). If HIZs and MCs were random, independent entities, then MC-HIZ coexistence at 1 level would have been expected in 67 × 77/193 (that is, 27) discs. The observed frequency was therefore significantly lower (χ2 = 41, p < 0.001). There were no significant demographic differences between groups. The HIZ disc height (8 ± 0.2 mm) was significantly greater than the MC (6.6 ± 0.2 mm) or MC-HIZ (6.7 ± 0.2 mm) disc heights (p < 0.001). Conclusions: In patients with discogenic CLBP associated with HIZ or MC lesions, MC-HIZ coexistence at 1 level was significantly rarer than expected even by chance; thus, despite both being manifestations of a seemingly common degenerative process, HIZ and MC more closely represent “either/or” phenomena. Because HIZ disc height was significantly greater, HIZs may develop earlier in the disc degenerative ontogeny. If any degenerative disc may only display an HIZ first, yet may ultimately display an MC instead, then HIZs must invariably regress as MCs supervene (or even vice versa). The MC-HIZ coexistence would therefore represent either a rare stable state (possibly more common in females) or a transitory state, as one lesion gradually replaces the other. Longitudinal studies would confirm or refute these hypotheses, although significantly larger sample sizes would be required.
Keywords: Modic change; high-intensity zone; chronic low-back pain.
Rights: © 2010 American Association of Neurosurgeons
RMID: 0020095880
DOI: 10.3171/2009.10.SPINE08856
Appears in Collections:Mathematical Sciences publications
Environment Institute publications

Files in This Item:
There are no files associated with this item.


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.