# Abstract

 

## Objective To determine abnormal MRI findings in adults hospitalized with acute severe axial LBP. 

## Method Sixty patients with back pain were divided into 3 groups consisting of 1) 23 adults with acute axial severe LBP who could not sit up or stand up for several days, but had not experienced previous back-related diseases or trauma (group A), 2) 19 adults who had been involved in a minor traffic accident, and had mild symptoms but not limited mobility (group B), and 3) 18 adults with LBP with radicular pain (group C)., Various MRI findings were assessed among the above 3 groups and compared as follows: disc herniation (protrusion, extrusion), lumbar disc degeneration (LDD), annular tear, high intensity zone (HIZ), and endplate changes. 

## Results The MRI findings of A group were as follows: disc herniation (87%), LDD (100%), annular tear (100%), HIZ (61%), and end plate changes (4.4%). The findings of disc herniation, annular tear, HIZ, and LDD were more prevalent in A group than in B group (p\<0.01). HIZ findings were more prevalent in A group than in group B or group C (p\<0.05). 

## Conclusion Patients with acute severe axial LBP were more likely to have disc herniation, LDD, annular tear, HIZ. Among LBP groups, there was a significant association of HIZ on MRI with acute severe axial LBP. # RESULTS The frequencies of the MRI findings were as follows: In patients with acute lower back pain (group A), disc herniation (87%), LDD (100%), annular tear (100%), HIZ (61%), and Modic change (4.4%); in patients with mild lower back pain caused by a simple vehicle accident (control group B), disc herniation (31.6%), LDD (47.4%), annulus tear (26.3%), HIZ (21.1%), and Modic change (10.5%); and in patients with severe radiating lower back pain (control group C), disc herniation (100%), LDD (100%), annulus tear (94.4%), HIZ (16.7%), and Modic changes (27.7%) ([Table 1](#)). In all groups, (80%) of the disc changes were in L4-5 and L5-S1 ([Table 2](#)). There were significant differences in the disc herniation, HDD, annulus tear, and HIZ between the patients with acute severe lower back pain (group A) and the control group B (p\<0.05) ([Table 3](#)). The proportion of HIZ incidence was significantly higher in group A than in control group B, and in the patients with severe radiating pain (control group C) (p\<0.05) ([Table 3](#)). It was difficult to give clinical meaning to the Modic change, as its frequency was low. <figure> <p><img src="" /></p> <figcaption>Magnetic resonance images of high intensity zone (HIZ), (A) The sagittal T2-weighted magnetic resonance image showing a HIZ (arrow) within the posterior annulus at L5-S1, (B) The axial T2-weighted magnetic resonance image shows a HIZ (arrow) within the posterior annulus at L5-S1.</figcaption> </figure> <figure> <p><img src="" /></p> <figcaption>Magnetic resonance images of lumbar disc degeneration (LDD). The sagittal T2-weighted magnetic resonance image at L3-L4 and L4-L5 levels shows a degenerative signal loss with mild height reduction (arrows).</figcaption> </figure> <figure> <p><img src="" /></p> <figcaption>Magnetic resonance images of Modic change. Modic type I (arrows): hypointense on T1-weighted magnetic resonance image (A) and hyperintense on T2-weighted magnetic resonance image (B).</figcaption> </figure> <figure> <p><img src="" /></p> <figcaption>Magnetic resonance images of Modic change. Modic type II (arrows): hyperintense on T1-weighted magnetic resonance image (A) and hyperintense on T2-weighted magnetic resonance image (B).</figcaption> </figure> ::::table-wrap

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General Characteristics of Subjects
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LBP: Low back pain, TA: Traffic accident:::: ::::table-wrap
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Distribution of MR Findings among 3 Groups
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LBP: Low back pain, TA: Traffic accident:::: ::::table-wrap
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Correlation between the Presence of MR Abnormality and the LBP Groups
(chi-square test)
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^\*^Correlation between acute severe LBP and mild LBP with minor TA;
^†^Correlation among all LBP groups

LBP: Low back pain, TA: Traffic accident::::


Extracted trial result:
Outcome: differences in the HIZ (binary)
Intervention: adults with acute axial severe LBP who could not sit up or stand up for several days, but had not experienced previous back-related diseases or trauma (group A)
Comparator: adults who had been involved in a minor traffic accident, and had mild symptoms but not limited mobility (group B)
Intervention events: 14
Intervention group size: 23
Comparator events: 4
Comparator group size: 19
Notes: Used percentage to calculate events as binary outcome.