A painful disc is arguably the most common cause of low back pain. This develops as the structures in between the vertebrae, called the intervertebral discs, begin to fissure and split as it is stressed in abnormal ways. One of the ways we identify this is in the history of a patient’s complaints. Often, a patient will explain that they get back pain when bending forward and somewhat relieved when bending backwards.
When it comes to imaging studies, MRI can see these fissures and reported by radiologists as a high intensity zone (HIZ). This is a white spot seen on T2 weighted imaging.
The small white spot in the above image may look small but it can be very sensitive and often split further when in flexion with load (bending forward).
In a recent research article, some authors looked to further identify a painful disc and encouraged the observation within MRI imaging.
In conclusion, they believed that low back pain is not merely an incidental finding on MRI for degenerative discs and should be taken seriously.
In Nanaimo, I have found that this is often overlooked in the radiological investigation and reading of MRIs of low back pain and leg pain patients. High intensity zones are an important part of figuring out why a patient hurts. A second interpretation of the MRI is sometimes warranted.
A careful spinal examination, with imaging, can often point to a specific pain generator and in turn, guide the treatment plan. Clues involve pain upon flexion and stiffness upon prolonged sitting.