Low back pain associated with lumbar disc herniation: role of moderately degenerative disc and annulus fibrous tears.
Lumbar disc herniation is one of the most common spinal degenerative disorders which may lead to low back pain (LBP) and radicular leg pain. However, it remains difficult to diagnose a degenerative herniated disc as the LBP generator in clinical practice. The purpose of this study is to explore the characteristic changes of a herniated disc causing LBP on MRI and to clarify the underlying role of inflammatory mediators and annulus fibrous (AF) tears in LBP generation associated with disc herniation. We prospectively collected intervertebral disc specimens and MRI from 57 single-segment disc herniation patients with radiculopathy. All subjects were grouped according to LBP occurrence or disc degeneration severity for the comparison of inflammatory mediators' expression and AF tears occurrence (High Intensity Zone, HIZ, on MRI). LBP incidence under circumstances of different degeneration severity with or without HIZ was further analyzed. Both LBP incidence and Inflammatory mediators expression in moderately degenerated group was higher than mildly and severely degenerative groups. HIZ incidence was higher in moderately and severely degenerated groups. LBP incidence in the patients with both moderately degenerated discs and HIZ was 86.7%, much higher than the rest of the patient population. In conclusion, the high expression of inflammatory mediators with AF tears causes LBP associated with disc herniation. Moderately degenerative disc with HIZ is MRI morphological change of herniated disc causing LBP, which can be applied to diagnose LBP.
Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-Sen University 58 Zhongshan 2nd Road, Guangzhou 510080, China ; Department of Spine Surgery, Beijing Jishuitan Hospital, Peking University 31 Xinjiekou Dongjie, Beijing 100035, China.
Hao
H
Yang
Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-Sen University 58 Zhongshan 2nd Road, Guangzhou 510080, China.
Hui
H
Liu
Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-Sen University 58 Zhongshan 2nd Road, Guangzhou 510080, China.
Zemin
Z
Li
Department of Orthopedics, The Fifth Affiliated Hospital, Sun Yat-Sen University 52 Meihua East Road, Zhuhai 519000, China.
Kuibo
K
Zhang
Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-Sen University 58 Zhongshan 2nd Road, Guangzhou 510080, China.
Jianru
J
Wang
Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-Sen University 58 Zhongshan 2nd Road, Guangzhou 510080, China.
Hua
H
Wang
Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-Sen University 58 Zhongshan 2nd Road, Guangzhou 510080, China.
Zhaomin
Z
Zheng
Low back pain; annulus fibrous tear; high intensity zone; inflammatory cytokine; lumbar disc herniation