PMC8769472_01
HIZs and Modic type 1 change. (a-c) STIR MRI before surgery shows HIZs in the discs at L4/5 and L5/S1 (arrows). (d and e) On STIR-MRI, a mid-sagittal view shows Modic type 1 change in the lower part of the endplate at L4 and in the upper part of the endplate at L5 (arrows) and a right para-sagittal view shows Modic type 1 change in the L5 and sacral endplates (arrows). HIZs: high-intensity zones, MRI: magnetic resonance imaging, STIR: short T1 inversion recovery.
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F1
A T2-weighted sagittal MRI scan (Fig. 1a) showed grade IV degenerative disc changes at L4/5 and L5/S1 with slight collapse of the disc spaces. Although slight disc bulging was observed at L4/5 and L5/S1 on axial views, there was no compression of nerve structures such as the nerve roots, cauda equina, and dura mater (Fig. 1b and 1c). T1 inversion recovery (STIR) images showed HIZ lesions in the posterior parts of the L4/5 and L5/S1 discs. There were also low-intensity changes on a T1-weighted image and high-intensity changes on T2-weighted and STIR images at the L4, L5, and sacral endplates, indicating Modic type 1 change (Fig. 1d and 1e).
CT scan after discography shows an annular tear at the L4/5 disc (arrow). CT: computed tomography.
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Computed tomography scans after discography showed an annular tear (Fig. 2).
Endoscopic findings. Endoscopic views of the L4/5 disc show the red flare tissue at the site of the annular tear in the disc at L4/5 (arrows, left and center). The bleeding site was ablated by TA using a radiofrequency coagulator (right). TA: thermal annuloplasty.
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After removing the red inflamed tissue, the bleeding site was ablated using a radiofrequency coagulator (i.e., TA; Fig. 3).
Imaging findings before and after surgery. MRI obtained before and 3 months after the surgery show improvement of the Modic type 1 change at L4/5 improved after surgery. MRI: magnetic resonance imaging.
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MRI scans acquired 3 months after surgery revealed a lessening of the signal change at the L4, L5, and sacral endplates (Fig. 4).