High-Intensity Zones on MRI of the Cervical Spine in Patients: Epidemiology and Association With Pain and Disability. Issue 5 (June 2022)

• Record Type: Journal Article
• Authors: Nguyen, Austin Q.; Harada, Garrett K.; Leverich, Kayla L.; Khanna, Krishn; Louie, Philip K.; Basques, Bryce A.; Tao, Youping; Galbusera, Fabio; Niemeyer, Frank; Wilke, Hans-Joachim; An, Howard S.; Samartzis, Dino
• Is Part Of: Global spine journal. Volume 12:Issue 5(2022)
• Page Start: 829
• Page End: 839
• Publication Date: 2022-06
• Subjects: high-intensity zones -- HIZ -- disc -- MRI -- neck pain -- cervical -- degenerative -- disease -- low back pain; Spine -- Diseases -- Periodicals; Spine -- Diseases -- Treatment -- Periodicals; Spine -- Abnormalities -- Periodicals; Spine -- Surgery -- Periodicals; 616.73
• DOI: 10.1177/2192568220966328
• Languages: English
• ISSNs: 2192-5682

Abstract

Study Design: Retrospective cohort study. Objectives: This study aimed to address the prevalence, distribution, and clinical significance of cervical high-intensity zones (HIZs) on magnetic resonance imaging (MRI) with respect to pain and other patient-reported outcomes in the setting of patients that will undergo an anterior cervical discectomy and fusion (ACDF) procedure. Methods: A retrospective cohort study of ACDF patients surgically treated at a single center from 2008 to 2015. Based on preoperative MRI, HIZ subtypes were identified as either traditional T2-hyperintense, T1-hypointense ("single-HIZs"), or combined T1- and T2-hyperintense ("dual-HIZs"), and their level-specific prevalence was assessed. Preoperative symptoms, patient-reported outcomes, and disc degeneration pathology were assessed in relation to HIZs and HIZ subtypes. Results: Of 861 patients, 58 demonstrated evidence of HIZs in the cervical spine (6.7%). Single-HIZs and dual-HIZs comprised 63.8% and 36.2% of the overall HIZs, respectively. HIZs found outside of the planned fusion segment reported better preoperative Neck Disability Index (NDI; P = .049) and Visual Analogue Scale (VAS) Arm ( P = .014) scores relative to patients without HIZs. Furthermore, patients with single-HIZs found inside the planned fusion segment had worse VAS Neck ( P = .045) and VAS Arm ( P = .010) scores. In general, dual-HIZ patients showed no significant differences across all clinical outcomes. Conclusions: This is the first study to evaluate the clinical significance of HIZs in the cervical spine, noting level-specific and clinical outcome–specific variations. Single-HIZs were associated with significantly more pain when located inside the fusion segment, while dual-HIZs showed no associations with patient-reported outcomes. The presence of single-HIZs may correlate with concurrent spinal pathologies and should be more closely evaluated.