Australian Patient Case: How an MRI-Detected HIZ Explained 12 Months of Sciatic Pain

Patient Information

Male in his 30s (Australian national)

Conditions & Symptoms

• HIZ (High Intensity Zone)
• Degenerative Disc Disease

Current Status

For the past year, the patient has suffered from persistent lower back pain and numbness/pain in his left leg. After seeing no improvement, he contacted Dr. Pauza in the United States, who then referred him to our clinic.

Examination

MRI Findings

The MRI revealed disc degeneration at L3/4, L4/5, and L5/S, with a clear HIZ (High Intensity Zone) observed at the L4/5 level.

While the disc bulging is visible on the right side, the patient's actual symptoms are occurring on the left—the opposite side of the imaging results.

Diagnosis

Patients are often surprised when we explain that disc degeneration and HIZ are the cause of their pain, but this is precisely because the root cause is inflammation. It is common to see cases where imaging shows nerve compression from a herniation yet the patient has no symptoms, or conversely, cases like this where there is no herniation or stenosis, but the pain is severe.

Treatment Plan

Despite his young age, the progression of the damage makes him an excellent candidate for the Discseel® Procedure to improve current symptoms and preserve the discs for the future. We did not limit treatment to just L3/4, 4/5, and 5/S. Our protocol dictates that we thoroughly examine discs adjacent to the damaged areas, even if they appear healthy at first glance. This case truly highlights the importance of that approach. Let’s proceed with the Annulogram.

Treatment

Annulogram

At L2/3, the MRI showed no signs of damage. However, the contrast imaging revealed unexpectedly significant damage! This is the moment I feel glad we performed a thorough check. Since the disc is still in relatively good condition, repairing it at this stage offers significant long-term benefits.

At L4/5, a major leak was found, exactly where the HIZ was located.

Pre- and Post-Treatment X-rays

We successfully performed the Discseel® Procedure on four discs, ensuring proper repair.

Summary

Since there is almost no stenosis visible on the imaging, the cause is highly likely to be inflammation. While we have high hopes for the treatment's effectiveness, we will be monitoring how much the year-long duration of symptoms has contributed to chronic pain. Even though he is an international patient, we will provide thorough follow-up care. No matter how many cases I experience, there is always more to learn; I remain committed to performing examinations and treatments with strict adherence to the fundamentals.

A Word from the Vice Director

It’s getting colder lately. Every morning, I commute by bicycle down from halfway up a mountain. Recently, as soon as I started the descent, I felt a piercing pain in both ankles. Looking down, I realized I was wearing ankle-length socks, and my skin was literally screaming from the cold! I barely made it to the station. Tomorrow, I’ll make sure to wear long socks.