The Expression of Tumor Necrosis Factor-α and CD68 in High-Intensity Zone of Lumbar Intervertebral Disc on Magnetic Resonance Image in the Patients With Low Back Pain

Ren, Dazhong; Hou, Shuxun; Wu, Wenwen; Wang, Huadong; Shang, Wei-lin; Tang, Jiaguang; Li, Zhenzhou; Guo, Lei

doi:10.1097/brs.0b013e3181dfce9e

Cited by 48 publications

(46 citation statements)

References 23 publications

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“…Histological findings showed that the displaced mass with the HIZ contained many fibroblast-like cells and the matrix was fibrotic. This is in good agreement with previous histological studies on the HIZ [8, 9]. …”

Section: Discussionsupporting

confidence: 93%

“…Similar clinical studies followed [5–7]. Chen et al [6] reported a correlation between the HIZ and positive concordant pain on discography, and Peng et al [8] and Dongfeng et al [9] found inflammation and neovascularization on histological analysis of disc material in the HIZ. Physicians should therefore be aware of the significance of the HIZ when diagnosing discogenic pain.…”

Section: Introductionmentioning

confidence: 54%

“…Provocative discography has been reported to be effective for its diagnosis, but the technique is controversial due to its invasiveness [1, 2]. Instead, various MRI indicators have been investigated, and among them the HIZ has recently been reported by many reports to be an effective indicator for discogenic pain [4–9]. However, the significance of the HIZ remains to be established [9].…”

Section: Discussionmentioning

confidence: 99%

“…The majority of the HIZ was at the L4-5 or L5-S level, and 57.5% of the HIZ-positive patients were symptomatic. Although some researchers do not consider HIZ to be related to low back pain, many clinical studies and histological investigations have shown that the HIZ has the potential to be a good indicator for discogenic low back pain [9]. …”

Section: Discussionmentioning

confidence: 99%

“…Findings revealed the formation of vascularized granulation tissue in the outer region of the annulus fibrosus, suggesting that the HIZ can be a good indicator for discogenic low back pain. More recently in 2011, Dongfeng et al [9] evaluated inflammatory reactions at the HIZ site using an immunohistochemical technique. They analyzed disc tissue samples taken from 26 patients during lumbar interbody fusion surgery and found that the disc tissue with an HIZ had a proliferation of small round cells and fibroblasts.…”

Section: Discussionmentioning

confidence: 99%

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Discoscopic Findings of High Signal Intensity Zones on Magnetic Resonance Imaging of Lumbar Intervertebral Discs

Sugiura

Tonogai

Matsuura

et al. 2014

Case Reports in Orthopedics

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A 32-year-old man underwent radiofrequency thermal annuloplasty (TA) with percutaneous endoscopic discectomy (PED) under local anesthesia for chronic low back pain. His diagnosis was discogenic pain with a high signal intensity zone (HIZ) in the posterior corner of the L4-5 disc. Flexion pain was sporadic, and steroid injection was given twice for severe pain. After the third episode of strong pain, PED and TA were conducted. The discoscope was inserted into the posterior annulus and revealed a migrated white nucleus pulposus which was stained blue. Then, after moving the discoscope to the site of the HIZ, a migrated slightly red nucleus pulposus was found, suggesting inflammation and/or new vessels penetrating the mass. After removing the fragment, the HIZ site was ablated by TA. To our knowledge, this is the first report of the discoscopic findings of HIZ of the lumbar intervertebral disc.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Discoscopic Findings of High Signal Intensity Zones on Magnetic Resonance Imaging of Lumbar Intervertebral Discs

Sugiura

Tonogai

Matsuura

et al. 2014

Case Reports in Orthopedics

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Discogenic Back Pain: Literature Review of Definition, Diagnosis, and Treatment

et al. 2019

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Discogenic back pain is multifactorial; hence, physicians often struggle to identify the underlying source of the pain. As a result, discogenic back pain is often hard to treat—even more so when clinical treatment strategies are of questionable efficacy. Based on a broad literature review, our aim was to define discogenic back pain into a series of more specific and interacting pathologies, and to highlight the need to develop novel approaches and treatment strategies for this challenging and unmet clinical need. Discogenic pain involves degenerative changes of the intervertebral disc, including structural defects that result in biomechanical instability and inflammation. These degenerative changes in intervertebral discs closely intersect with the peripheral and central nervous systems to cause nerve sensitization and ingrowth; eventually central sensitization results in a chronic pain condition. Existing imaging modalities are nonspecific to pain symptoms, whereas discography methods that are more specific have known comorbidities based on intervertebral disc puncture and injection. As a result, alternative noninvasive and specific diagnostic methods are needed to better diagnose and identify specific conditions and sources of pain that can be more directly treated. Currently, there are many treatments/interventions for discogenic back pain. Nevertheless, many surgical approaches for discogenic pain have limited efficacy, thus accentuating the need for the development of novel treatments. Regenerative therapies, such as biologics, cell‐based therapy, intervertebral disc repair, and gene‐based therapy, offer the most promise and have many advantages over current therapies. © 2019 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research

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Simulation of water content distributions in degenerated human intervertebral discs

Zhu

Gao

Brown

et al. 2016

Journal Orthopaedic Research

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The objective of this study was to investigate the spatial and temporal variations of water content in intervertebral discs during degeneration and repair processes. We hypothesized that the patterns of water content distribution in the discs are related to the intensity patterns observed in T2-weighted MRI images. Water content distributions in the mildly (e.g., 80% viable cells in the disc, 2.3% decrease in disc height) and moderately (e.g., 40% viable cells in the disc, 9.3% decrease in disc height) degenerated discs were predicted using a finite element model. The variation of water content in the degenerated discs treated with three biological therapies [i.e., increasing the cell density in the NP (Case I), increasing glycosaminoglycan synthesis rate in the nucleus pulposus (Case II), and decreasing glycosaminoglycan degradation rate in the nucleus pulposus (Case III)] were also predicted. It was found that two patterns of water content distributions, a horizontal region with lower water content at the mid-axial plane of nucleus pulposus and a spot with higher water content at the posterior region, were shown during the degeneration progress for the disc simulated in this study. These two patterns disappeared after treatment in Case I, but in Case II and Case III. The implication of these patterns for the horizontal gray band and high intensity zone in T2-weighted MRI images was discussed. This study provided new guidance to develop a novel method for diagnosing disc degeneration and assessing outcomes of biological therapies with MRI techniques.

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The Expression of Tumor Necrosis Factor-α and CD68 in High-Intensity Zone of Lumbar Intervertebral Disc on Magnetic Resonance Image in the Patients With Low Back Pain

Abstract: The results of this study indicate that HIZ may be a specific signal for the inflammatory reaction of painful intervertebral disc.

Cited by 48 publications

References 23 publications

Discoscopic Findings of High Signal Intensity Zones on Magnetic Resonance Imaging of Lumbar Intervertebral Discs

Discoscopic Findings of High Signal Intensity Zones on Magnetic Resonance Imaging of Lumbar Intervertebral Discs

Discogenic Back Pain: Literature Review of Definition, Diagnosis, and Treatment

Simulation of water content distributions in degenerated human intervertebral discs

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