Analysis of the Prevalence of Lumbar Annular Tears in Adult Patients Using Magnetic Resonance Imaging Data
-
Mohammad Davoudi
,
Rahman S. Zabibah
,
Andrés Alexis Ramírez-Coronel
,
Ali Hussein Demin Al-Khafaji
,
Acim Heri Iswanto
,
Gholamreza Ataei
,
Elham Yousefi
,
Fatemeh Zahra Nosrati
,
Danial Fazilat-Panah
Abstract
Purpose: This study aimed to evaluate the lumbar annular tears prevalence regarding the patient’s history factors, and Magnetic Resonance Imaging (MRI) recorded data.
Materials and Methods: In this study, 218 patients (106 men and 112 women) were evaluated; 136 cases (63 men and 73 women, 20-80 years, mean: 45.4±14.8 years) with Lower Back Pain (LBP) and High-Intensity Zone (HIZ) were diagnosed based on MR images. The diagnosed annular tears from the MRI data, Body Mass Index (BMI, kg/m2), and physical activity of the patients were recorded, and the prevalence of lumbar annular tears was evaluated regarding the mentioned parameters.
Results: The prevalence of annular tears was 31.6% at L5/S1 (43/136 patients), 43.4% at L4/L5 (59/136 patients), 16.9% at L3/L4 (23/136 patients), 4.4% at L2/L3 (6/136 patients), and 3.7% at L1/L2 spinal disc space (5/136 patients). Most patients with annular tears had LBP (>60%). Based on the patient's history, 25% of patients had BMI above 30, 8.8% had post-traumatic history, 15.4% had a history of falling down, 19.1% had slipped down history, 16.2% were athletes, and 15.4% performed heavy work.
Conclusion: The prevalence of lumbar annular tears was higher in patients having LBP and a BMI over 30, which should be considered possible risk factors. This study demonstrated that annular tears are more likely to occur in lower lumbar discs, especially in L4/L5 and L5/S1 discs.
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2- Yin-gang Zhang, Tuan-mao Guo, Xiong Guo, and Shi-xun Wu, "Clinical diagnosis for discogenic low back pain." International journal of biological sciences, Vol. 5 (No. 7), p. 647, (2009).
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5- Zhi Shan, Huanhuan Chen, Junhui Liu, Hong Ren, Xuyang Zhang, and Fengdong Zhao, "Does the high-intensity zone (HIZ) of lumbar Intervertebral discs always represent an annular fissure?" European radiology, Vol. 27 (No. 3), pp. 1267-76, (2017).
6- Michael T Modic and Jeffrey S Ross, "Lumbar degenerative disk disease." Radiology, Vol. 245 (No. 1), pp. 43-61, (2007).
7- Victor Haughton, "Imaging intervertebral disc degeneration." Jbjs, Vol. 88 (No. suppl_2), pp. 15-20, (2006).
8- Pokhraj Suthar, Rupal Patel, Chetan Mehta, and Narrotam Patel, "MRI evaluation of lumbar disc degenerative disease." Journal of clinical and diagnostic research: JCDR, Vol. 9 (No. 4), p. TC04, (2015).
9- Pang Hung Wu, Hyeun Sung Kim, and Il-Tae Jang, "Intervertebral disc diseases PART 2: a review of the current diagnostic and treatment strategies for intervertebral disc disease." International journal of molecular sciences, Vol. 21 (No. 6), p. 2135, (2020).
10- A Splendiani et al., "Imaging of post-operative spine in intervertebral disc pathology." Musculoskeletal surgery, Vol. 101 (No. 1), pp. 75-84, (2017).
11- Mohammad Davoudi and Shaghayegh Lotfian Ahangarkolaei, "Image optimization and reduction of radiation dose in CT of the paranasal sinuses." Biomedical Physics & Engineering Express, Vol. 6 (No. 4), p. 045021, (2020).
12- Ali Tarighatnia, Gurkaran Johal, Ayuob Aghanejad, Hossein Ghadiri, and Nader D Nader, "Tips and Tricks in Molecular Imaging." Frontiers in Biomedical Technologies, Vol. 8 (No. 3), pp. 226-35, (2021).
13- A Sharma, T Pilgram, and FJ Wippold, "Association between annular tears and disk degeneration: a longitudinal study." American journal of neuroradiology, Vol. 30 (No. 3), pp. 500-06, (2009).
14- I Khan, R Hargunani, and A Saifuddin, "The lumbar high-intensity zone: 20 years on." Clinical radiology, Vol. 69 (No. 6), pp. 551-58, (2014).
15- Oded Hershkovich et al., "Associations of body mass index and body height with low back pain in 829,791 adolescents." American journal of epidemiology, Vol. 178 (No. 4), pp. 603-09, (2013).
16- M Liuke et al., "Disc degeneration of the lumbar spine in relation to overweight." International journal of obesity, Vol. 29 (No. 8), pp. 903-08, (2005).
17- Xian Xu, Xu Li, and Wei Wu, "Association between overweight or obesity and lumbar disk diseases." Journal of Spinal Disorders and Techniques, Vol. 28 (No. 10), pp. 370-76, (2015).
18- Zi-Xuan Wang and You-Gu Hu, "Factors associated with lumbar disc high-intensity zone (HIZ) on T2-weighted magnetic resonance image: a retrospective study of 3185 discs in 637 patients." Journal of Orthopaedic Surgery and Research, Vol. 13 (No. 1), pp. 1-6, (2018).
19- CW Ernst, TW Stadnik, E Peeters, C Breucq, and MJC Osteaux, "Prevalence of annular tears and disc herniations on MR images of the cervical spine in symptom free volunteers." European journal of radiology, Vol. 55 (No. 3), pp. 409-14, (2005).
20- Xiaoli Wu et al., "The prevalence of moderate-to-high posttraumatic growth: A systematic review and meta-analysis." Journal of affective disorders, Vol. 243pp. 408-15, (2019).
21- Bolanle Tinubu, Chidozie E Mbada, Adewale L Oyeyemi, and Ayodele A Fabunmi, "Work-related musculoskeletal disorders among nurses in Ibadan, South-west Nigeria: a cross-sectional survey." BMC Musculoskeletal disorders, Vol. 11 (No. 1), pp. 1-8, (2010).
22- Zi-Xuan Wang and You-Gu Hu, "High-intensity zone (HIZ) of lumbar intervertebral disc on T2-weighted magnetic resonance images: spatial distribution, and correlation of distribution with low back pain (LBP)." European Spine Journal, Vol. 21 (No. 7), pp. 1311-15, (2012).
23- Nikolai Bogduk, "Degenerative joint disease of the spine." Radiologic Clinics of North America, Vol. 50 (No. 4), pp. 613-28, (2012).
24- C Aprill and N Bogduk, "High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging." The British journal of radiology, Vol. 65 (No. 773), pp. 361-69, (1992).
25- Baogan Peng, Shuxun Hou, Wenwen Wu, Chunli Zhang, and Yi Yang, "The pathogenesis and clinical significance of a high-intensity zone (HIZ) of lumbar intervertebral disc on MR imaging in the patient with discogenic low back pain." European Spine Journal, Vol. 15 (No. 5), pp. 583-87, (2006).
26- Chae-Hun Lim, Won-Hee Jee, Byung Chul Son, Dong-Hyun Kim, Kee-Yong Ha, and Chun-Kun Park, "Discogenic lumbar pain: association with MR imaging and CT discography." European journal of radiology, Vol. 54 (No. 3), pp. 431-37, (2005).
27- B Böhm, H Meinig, A Eckardt, S Schadmand-Fischer, and J Heine, "Correlation of degenerative intervertebral disk displacement using MRI with discography findings in patients with back pain." Der Orthopade, Vol. 34 (No. 11), pp. 1144-49, (2005).
28- Zi-Xuan Wang, You-Gu Hu, and Xiang-Min Chen, "Significance of the high-intensity zone located in the posterior annulus fibrosus for diagnosing discogenic low back pain." Zhonghua Yi Xue Za Zhi, Vol. 88 (No. 35), pp. 2478-81, (2008).
29- Huadong Wang et al., "Correlation between high-intensity zone on MRI and discography in patients with low back pain." Medicine, Vol. 96 (No. 30), (2017).
30- Jian-yu Chen et al., "Correlation between MR imaging and discography with provocative concordant pain in patients with low back pain." The Clinical journal of pain, Vol. 27 (No. 2), pp. 125-30, (2011).
31- Norbert Boos, Sabine Weissbach, Helmut Rohrbach, Christoph Weiler, Kevin F Spratt, and Andreas G Nerlich, "Classification of age-related changes in lumbar intervertebral discs: 2002 Volvo Award in basic science." Spine, Vol. 27 (No. 23), pp. 2631-44, (2002).
32- OL Osti, B Vernon-Roberts, R Moore, and RD Fraser, "Annular tears and disc degeneration in the lumbar spine. A post-mortem study of 135 discs." The Journal of bone and joint surgery. British volume, Vol. 74 (No. 5), pp. 678-82, (1992).
33- Maureen C Jensen, Michael N Brant-Zawadzki, Nancy Obuchowski, Michael T Modic, Dennis Malkasian, and Jeffrey S Ross, "Magnetic resonance imaging of the lumbar spine in people without back pain." New England Journal of Medicine, Vol. 331 (No. 2), pp. 69-73, (1994).
34- Tadeusz W Stadnik, Roland R Lee, Hugo L Coen, EC Neirynck, Therese S Buisseret, and MJ Osteaux, "Annular tears and disk herniation: prevalence and contrast enhancement on MR images in the absence of low back pain or sciatica." Radiology, Vol. 206 (No. 1), pp. 49-55, (1998).
35- Carl Hirsch and Fritz Schajowicz, "Studies on structural changes in the lumbar annulus fibrosus." Acta Orthopaedica Scandinavica, Vol. 22 (No. 1-4), pp. 184-231, (1952).
36- Timothy A Mirtz and Leon Greene, "Is obesity a risk factor for low back pain? An example of using the evidence to answer a clinical question." Chiropractic & osteopathy, Vol. 13 (No. 1), pp. 1-6, (2005).
2- Yin-gang Zhang, Tuan-mao Guo, Xiong Guo, and Shi-xun Wu, "Clinical diagnosis for discogenic low back pain." International journal of biological sciences, Vol. 5 (No. 7), p. 647, (2009).
3- Jan Willem Kallewaard et al., "Discogenic low back pain." Evidence‐Based Interventional Pain Medicine: According to Clinical Diagnoses, pp. 107-22, (2011).
4- Richard Derby, Byung-Jo Kim, Yung Chen, Kwan-Sik Seo, and Sang-Heon Lee, "The relation between annular disruption on computed tomography scan and pressure-controlled diskography." Archives of physical medicine and rehabilitation, Vol. 86 (No. 8), pp. 1534-38, (2005).
5- Zhi Shan, Huanhuan Chen, Junhui Liu, Hong Ren, Xuyang Zhang, and Fengdong Zhao, "Does the high-intensity zone (HIZ) of lumbar Intervertebral discs always represent an annular fissure?" European radiology, Vol. 27 (No. 3), pp. 1267-76, (2017).
6- Michael T Modic and Jeffrey S Ross, "Lumbar degenerative disk disease." Radiology, Vol. 245 (No. 1), pp. 43-61, (2007).
7- Victor Haughton, "Imaging intervertebral disc degeneration." Jbjs, Vol. 88 (No. suppl_2), pp. 15-20, (2006).
8- Pokhraj Suthar, Rupal Patel, Chetan Mehta, and Narrotam Patel, "MRI evaluation of lumbar disc degenerative disease." Journal of clinical and diagnostic research: JCDR, Vol. 9 (No. 4), p. TC04, (2015).
9- Pang Hung Wu, Hyeun Sung Kim, and Il-Tae Jang, "Intervertebral disc diseases PART 2: a review of the current diagnostic and treatment strategies for intervertebral disc disease." International journal of molecular sciences, Vol. 21 (No. 6), p. 2135, (2020).
10- A Splendiani et al., "Imaging of post-operative spine in intervertebral disc pathology." Musculoskeletal surgery, Vol. 101 (No. 1), pp. 75-84, (2017).
11- Mohammad Davoudi and Shaghayegh Lotfian Ahangarkolaei, "Image optimization and reduction of radiation dose in CT of the paranasal sinuses." Biomedical Physics & Engineering Express, Vol. 6 (No. 4), p. 045021, (2020).
12- Ali Tarighatnia, Gurkaran Johal, Ayuob Aghanejad, Hossein Ghadiri, and Nader D Nader, "Tips and Tricks in Molecular Imaging." Frontiers in Biomedical Technologies, Vol. 8 (No. 3), pp. 226-35, (2021).
13- A Sharma, T Pilgram, and FJ Wippold, "Association between annular tears and disk degeneration: a longitudinal study." American journal of neuroradiology, Vol. 30 (No. 3), pp. 500-06, (2009).
14- I Khan, R Hargunani, and A Saifuddin, "The lumbar high-intensity zone: 20 years on." Clinical radiology, Vol. 69 (No. 6), pp. 551-58, (2014).
15- Oded Hershkovich et al., "Associations of body mass index and body height with low back pain in 829,791 adolescents." American journal of epidemiology, Vol. 178 (No. 4), pp. 603-09, (2013).
16- M Liuke et al., "Disc degeneration of the lumbar spine in relation to overweight." International journal of obesity, Vol. 29 (No. 8), pp. 903-08, (2005).
17- Xian Xu, Xu Li, and Wei Wu, "Association between overweight or obesity and lumbar disk diseases." Journal of Spinal Disorders and Techniques, Vol. 28 (No. 10), pp. 370-76, (2015).
18- Zi-Xuan Wang and You-Gu Hu, "Factors associated with lumbar disc high-intensity zone (HIZ) on T2-weighted magnetic resonance image: a retrospective study of 3185 discs in 637 patients." Journal of Orthopaedic Surgery and Research, Vol. 13 (No. 1), pp. 1-6, (2018).
19- CW Ernst, TW Stadnik, E Peeters, C Breucq, and MJC Osteaux, "Prevalence of annular tears and disc herniations on MR images of the cervical spine in symptom free volunteers." European journal of radiology, Vol. 55 (No. 3), pp. 409-14, (2005).
20- Xiaoli Wu et al., "The prevalence of moderate-to-high posttraumatic growth: A systematic review and meta-analysis." Journal of affective disorders, Vol. 243pp. 408-15, (2019).
21- Bolanle Tinubu, Chidozie E Mbada, Adewale L Oyeyemi, and Ayodele A Fabunmi, "Work-related musculoskeletal disorders among nurses in Ibadan, South-west Nigeria: a cross-sectional survey." BMC Musculoskeletal disorders, Vol. 11 (No. 1), pp. 1-8, (2010).
22- Zi-Xuan Wang and You-Gu Hu, "High-intensity zone (HIZ) of lumbar intervertebral disc on T2-weighted magnetic resonance images: spatial distribution, and correlation of distribution with low back pain (LBP)." European Spine Journal, Vol. 21 (No. 7), pp. 1311-15, (2012).
23- Nikolai Bogduk, "Degenerative joint disease of the spine." Radiologic Clinics of North America, Vol. 50 (No. 4), pp. 613-28, (2012).
24- C Aprill and N Bogduk, "High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging." The British journal of radiology, Vol. 65 (No. 773), pp. 361-69, (1992).
25- Baogan Peng, Shuxun Hou, Wenwen Wu, Chunli Zhang, and Yi Yang, "The pathogenesis and clinical significance of a high-intensity zone (HIZ) of lumbar intervertebral disc on MR imaging in the patient with discogenic low back pain." European Spine Journal, Vol. 15 (No. 5), pp. 583-87, (2006).
26- Chae-Hun Lim, Won-Hee Jee, Byung Chul Son, Dong-Hyun Kim, Kee-Yong Ha, and Chun-Kun Park, "Discogenic lumbar pain: association with MR imaging and CT discography." European journal of radiology, Vol. 54 (No. 3), pp. 431-37, (2005).
27- B Böhm, H Meinig, A Eckardt, S Schadmand-Fischer, and J Heine, "Correlation of degenerative intervertebral disk displacement using MRI with discography findings in patients with back pain." Der Orthopade, Vol. 34 (No. 11), pp. 1144-49, (2005).
28- Zi-Xuan Wang, You-Gu Hu, and Xiang-Min Chen, "Significance of the high-intensity zone located in the posterior annulus fibrosus for diagnosing discogenic low back pain." Zhonghua Yi Xue Za Zhi, Vol. 88 (No. 35), pp. 2478-81, (2008).
29- Huadong Wang et al., "Correlation between high-intensity zone on MRI and discography in patients with low back pain." Medicine, Vol. 96 (No. 30), (2017).
30- Jian-yu Chen et al., "Correlation between MR imaging and discography with provocative concordant pain in patients with low back pain." The Clinical journal of pain, Vol. 27 (No. 2), pp. 125-30, (2011).
31- Norbert Boos, Sabine Weissbach, Helmut Rohrbach, Christoph Weiler, Kevin F Spratt, and Andreas G Nerlich, "Classification of age-related changes in lumbar intervertebral discs: 2002 Volvo Award in basic science." Spine, Vol. 27 (No. 23), pp. 2631-44, (2002).
32- OL Osti, B Vernon-Roberts, R Moore, and RD Fraser, "Annular tears and disc degeneration in the lumbar spine. A post-mortem study of 135 discs." The Journal of bone and joint surgery. British volume, Vol. 74 (No. 5), pp. 678-82, (1992).
33- Maureen C Jensen, Michael N Brant-Zawadzki, Nancy Obuchowski, Michael T Modic, Dennis Malkasian, and Jeffrey S Ross, "Magnetic resonance imaging of the lumbar spine in people without back pain." New England Journal of Medicine, Vol. 331 (No. 2), pp. 69-73, (1994).
34- Tadeusz W Stadnik, Roland R Lee, Hugo L Coen, EC Neirynck, Therese S Buisseret, and MJ Osteaux, "Annular tears and disk herniation: prevalence and contrast enhancement on MR images in the absence of low back pain or sciatica." Radiology, Vol. 206 (No. 1), pp. 49-55, (1998).
35- Carl Hirsch and Fritz Schajowicz, "Studies on structural changes in the lumbar annulus fibrosus." Acta Orthopaedica Scandinavica, Vol. 22 (No. 1-4), pp. 184-231, (1952).
36- Timothy A Mirtz and Leon Greene, "Is obesity a risk factor for low back pain? An example of using the evidence to answer a clinical question." Chiropractic & osteopathy, Vol. 13 (No. 1), pp. 1-6, (2005).
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| Issue | Vol 11 No 2 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/fbt.v11i2.15333 | |
| Keywords | ||
| Prevalence Annular tears High-intensity zone Low back pain MRI | ||
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How to Cite
1.
Davoudi M, Zabibah RS, Ramírez-Coronel AA, Demin Al-Khafaji AH, Iswanto AH, Ataei G, Yousefi E, Nosrati FZ, Fazilat-Panah D. Analysis of the Prevalence of Lumbar Annular Tears in Adult Patients Using Magnetic Resonance Imaging Data. Frontiers Biomed Technol. 2024;11(2):177-183.
