High-Intensity Zones on MRI of the Cervical Spine in Patients: Epidemiology and Association With Pain and Disability

Austin Q Nguyen, Garrett K Harada, Kayla L Leverich, Krishn Khanna, Philip K Louie, Bryce A Basques, Youping Tao, Fabio Galbusera, Frank Niemeyer, Hans-Joachim Wilke, Howard S An, Dino Samartzis

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)2192568220966328
JournalGlobal Spine Journal
Publication statusE-pub ahead of print - Nov 18 2020


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