Carragee E J, Paragioudakis S J, Khurana S
Division of Orthopaedic Spine Surgery, Stanford University, Stanford, California 94305, USA.
Spine (Phila Pa 1976). 2000 Dec 1;25(23):2987-92. doi: 10.1097/00007632-200012010-00005.
A prospective observational study of patients with low back pain and those without was performed.
To investigate the prevalence and significance of a high-intensity zone in a group of patients asymptomatic for low back pain, but who had known risk factors for lumbar disc degeneration. This asymptomatic group was compared with a symptomatic group of patients with respect to the presence of anular high-intensity zone and the pain response with discography.
Some authors have estimated the prevalence of a high-intensity zone in a group of symptomatic patients to be 86%. They have reported a strong correlation between a high-intensity zone and positive discography in patients with low back pain. Other investigators have reported evidence either supporting or discounting these findings.
Patients with low back pain and those without underwent physical examination, psychometric testing, plain radiograph, magnetic resonance imaging, and discography. The presence of a high-intensity zone, anular disruption, and positive discographic pain then were compared between the two groups. There were strict inclusion criteria for both groups. A total of 109 discs in 42 patients were evaluated in the symptomatic group and compared with 143 discs in 54 patients in the asymptomatic group. The presence of a high-intensity zone was determined by a standardized criteria on T2-weighted magnetic resonance images. Psychometric testing also was administered to each patient before discography. Standard discography was performed on all the patients, and the pain response was recorded using a visual analog scale according to the Walsh et al criteria.
The prevalence of a high-intensity zone in the patient populations was 59% in the symptomatic group and 24% in the asymptomatic group. In the symptomatic group, 33 (30.2%) of 109 discs were found to have a high-intensity zone. In the asymptomatic group, 13 of 143 discs were found to have a high-intensity zone. In the symptomatic group, 72.7% of the discs with a high-intensity zone were positive on discography, whereas 38.2% of the discs without a high-intensity zone were positive. In the asymptomatic group, 69.2% of the discs with a high-intensity zone were positive on discography, whereas 10% of the discs without a high-intensity zone were positive. In the patients with normal psychometric testing, 50% of the discs with a high-intensity zone were positive on discography, as compared with 100% positive discography results in patients with abnormal psychometric testing or chronic pain.
The presence of a high-intensity zone does not reliably indicate the presence of symptomatic internal disc disruption. Although higher in symptomatic patients, the prevalence of a high-intensity zone in asymptomatic individuals with degenerative disc disease (25%) is too high for meaningful clinical use. When injected during discography, the same percentage of asymptomatic and symptomatic discs with a high-intensity zone were shown to be painful.
对腰痛患者和无腰痛患者进行了一项前瞻性观察研究。
调查一组无腰痛症状但有腰椎间盘退变已知危险因素的患者中高强度区的患病率及意义。将该无症状组与有症状组患者在纤维环高强度区的存在情况及椎间盘造影的疼痛反应方面进行比较。
一些作者估计一组有症状患者中高强度区的患病率为86%。他们报告了腰痛患者中高强度区与阳性椎间盘造影之间存在强相关性。其他研究者报告了支持或反驳这些发现的证据。
对腰痛患者和无腰痛患者进行体格检查、心理测试、X线平片、磁共振成像和椎间盘造影。然后比较两组之间高强度区、纤维环破裂和阳性椎间盘造影疼痛的存在情况。两组都有严格的纳入标准。有症状组对42例患者的109个椎间盘进行了评估，并与无症状组54例患者的143个椎间盘进行比较。高强度区的存在通过T2加权磁共振图像上的标准化标准来确定。在椎间盘造影前也对每位患者进行了心理测试。对所有患者进行标准椎间盘造影，并根据沃尔什等人的标准使用视觉模拟量表记录疼痛反应。
有症状组患者人群中高强度区的患病率为59%，无症状组为24%。在有症状组中，109个椎间盘中有33个（30.2%）发现有高强度区。在无症状组中，143个椎间盘中有13个发现有高强度区。在有症状组中，有高强度区的椎间盘中72.7%在椎间盘造影时为阳性，而无高强度区的椎间盘中38.2%为阳性。在无症状组中，有高强度区的椎间盘中69.2%在椎间盘造影时为阳性，而无高强度区的椎间盘中10%为阳性。在心理测试正常的患者中，有高强度区的椎间盘中50%在椎间盘造影时为阳性，而心理测试异常或有慢性疼痛的患者椎间盘造影结果100%为阳性。
高强度区的存在并不能可靠地表明存在有症状的椎间盘内部破裂。尽管有症状患者中高强度区的患病率较高，但在有退行性椎间盘疾病的无症状个体中高强度区的患病率（25%）过高，无法用于有意义的临床应用。在椎间盘造影时注射时，有高强度区的无症状和有症状椎间盘显示疼痛的比例相同。
