Posterior Annulus and the High Intensity Zone – Research looks to sub-classify this MRI finding

posterior annulus

Discogenic pain is quite common. A finding on MRI that has been hotly debated is a hyperintensity zone, often seen within the posterior annulus of the intervertebral discs.

In a recent study published in PLOS One 1 researchers conducted the first large scale study to identify subclassifications of high intensity zones (HIZ). They looked at a cross sectional study of 814 participants both using T1 and T2 weighted imaging and created a morphological and topographical classification system. Findings included HIZs on the posterior annulus and anterior annulus.

High Intensity Zone, HIZ, Lumbar Disc, posterior annulus

They believe the results could help in the standardization of MRI findings in clinical and research settings.

MRI has been thought to be not very helpful in the early management of back pain. However, more research (like this) to extract MRI findings should help localize pain generators and direct patient care and treatments. Even if imaging is thought to be less than optimal in the early management of back pain 2 it is still important to look carefully at MRI and correlate a patient’s symptoms to help direct patient care. Otherwise, it is a bit of guessing game which structures are inflamed.

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Francis W. Smith MD Clinical Professor of Radiology Positional MRI Centre Woodend Hospital Aberdeen, Scotland


2 replies
  1. John Ventura
    John Ventura says:

    I’m not sure I get your point. As you note, outcomes are worse with early MRI (cost, disability), yet your argument seems to be the justification of MRI as it may someday be used to stratify care. It is too costly and too sensitive to be used as a stratification tool. There should be compelling reasons for the use of MRI in spine pain. The Clinical Reasoning in Spine Pain and StarTBack models are excellent low cost stratification tools, which help in choosing to use or not use MRI.

    • Jerome Fryer
      Jerome Fryer says:

      Thank you for your comment. The clinical trick is WHEN to consider MRI like in the case of a occult spondylolisthesis causing spinal stensosis, for example. To further look at the MR image should help us figure out what we are looking at and how it can relate to spinal pain in our patients. Michael Modic in 1988 opened a topic based on his observations and what we now consider an important finding in spine pain. Others are as well
      Of course MRI is expensive but I disagree them being inappropriate as a stratification tool. It is when and how you use them. The point of this post is to highlight important MRI research and how we can share those findings with our patients.


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