Modic Vertebral Body Changes
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Abstract:
Changes in the vertebral body adjacent to the end plate may be associated with degenerative disc disease. These changes can be separated on magnetic resonance imaging (MRI) and have been described by Modic. It is assumed that these end plate changes represent a process that is progressive.We have retrospectively reviewed patients who had sequential MRI of the lumbar spine to investigate the natural history of Modic vertebral body MRI changes.Of 36 end plates with Modic type 1 changes in a first MRI, 18 remained the same, 13 progressed to Modic type 2 change, 3 progressed to Modic type 3 changes, and 2 end plates were found to be normal (type 0) on a subsequent MRI. Of the 22 end plates initially reported as Modic type 2 in a first MRI, 18 remained unchanged, none converted to Modic type 3, and 4 converted from Modic type 2 to Modic type 1 on a subsequent MRI.Magnetic resonance (MR) images of the lumbar spine of 49 subjects were assessed by a senior spinal surgeon. The lumbar vertebral body adjacent to the end plate was classified by using the Modic system from L1 to S1 inclusive.Of the 36 end plates with Modic 1 changes in the first data set, 18 remained the same; 13 progressed to Modic 2; 3 progressed to Modic 3 changes, and, interestingly, 2 end plates were found to be normal on the repeat scan. Of the 22 end plates initially reported as Modic 2, 18 remained unchanged; none converted to Modic 3 and 4 converted back from Modic 2 to Modic 1.Our findings reflect the dynamic nature of pathological changes in the spine and have demonstrated that Modic changes are reversible. They also raise further doubt that these MRI changes should be used as an indicator of clinical symptoms or of surgical outcome.Keywords:
Modic changes
Modic changes
Infiltration (HVAC)
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Modic changes
Back Pain
Disc protrusion
Intervertebral Disc
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Modic changes
Discography
Back Pain
Disc protrusion
Lumbar disc disease
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Abstract Background Low back pain is common and a significant number of patients experience chronic low back pain. Current treatment options offer small to moderate effects. Patients with vertebral bone marrow lesions visualized as Modic changes on magnetic resonance imaging may represent a subgroup within the low back pain population. There is evidence for inflammatory mediators being involved in development of Modic changes; hence, suppression of inflammation could be a treatment strategy for these patients. This study examines the effect of anti-inflammatory treatment with the TNF-α inhibitor infliximab in patients with chronic low back pain and Modic changes. Methods/design The BackToBasic trial is a multicenter, double blind, randomized controlled trial conducted at six hospitals in Norway, comparing intravenous infusions with infliximab with placebo. One hundred twenty-six patients aged 18–65 with chronic low back pain and type 1 Modic changes will be recruited from secondary care outpatients’ clinics. The primary outcome is back pain-specific disability at day 154 (5 months). The study is designed to detect a difference in change of 10 (SD 18) in the Oswestry Disability Index at day 154/ 5 months. The study also aims to refine MRI-assessment, investigate safety and cost-effectiveness and explore the underlying biological mechanisms of Modic changes. Discussion Finding treatments that target underlying mechanisms could pose new treatment options for patients with low back pain. Suppression of inflammation could be a treatment strategy for patients with low back pain and Modic changes. This paper presents the design of the BackToBasic study, where we will assess the effect of an anti-inflammatory treatment versus placebo in patients with chronic low back pain and type 1 Modic changes. The study is registered at ClinicalTrials.gov under the identifier NCT03704363 . The EudraCT Number: 2017–004861-29.
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Objective: To discuss the correlation between Modic degeneration of lumbar endplate on MRI and degeneration of lumbar intervertebral disc in low back pain. Methods: The routine X-ray and MRI were performed in 90 patients with 270 lumbar discs. The lumbar endplate changes were divided into 0～3 grades by Modic classification and the degeneration of vertebral discs were divided into Ⅰ～Ⅴ grades by Pearce classification system. All the data were analyzed by SPSS 11.5 for the correlations. Results: There was significant correlation(Pearson R=0.452, P=0.000), between the Modic degeneration of lumbar endplate and the degeneration of lumbar discs in 90 patients. Conclusion: There is positive correlation between Modic degeneration of lumbar endplate and the degeneration of lumbar intervertebral disc. It suggests Modic degeneration of lumbar endplate and the degeneration of lumbar intervertebral disc might be the cause and effect of each other. Both of them might be the causes of low back pain.
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Intervertebral Disc
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Modic I vertebral end-plate signal changes detected by magnetic resonance imaging (MRI) are associated with chronic low back pain. Typically, Modic I signal changes in untreated patients switch to non-Modic I signal changes within 3 years, which reflect spontaneous healing. Recent findings suggest that Modic I signal changes may be related to local inflammatory changes, providing a rationale for treatment with intradiscal injections of antiinflammatory drugs. In the present report, we describe a 31-year-old man with 1-year history of chronic low back pain associated with vertebral end-plate Modic I signal changes, who received 1 intradiscal corticosteroid injection in L5-S1. Local treatment led to rapid pain relief and was associated with an accelerated switch from Modic I to Modic 0 signal changes, as seen on lumbar MRI at 1-month followup. This is the first report of an effective local treatment for both the symptoms and the structural changes of chronic low back pain that are associated with Modic I signal changes. Additionally, this case reinforces the hypothesis that local inflammation has a pathogenic role.
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The prevalence of low-back pain (LBP) in adolescents ranges from 7 to 72%. We aimed to define the radiologic characteristics of the lumbar spine in children and adolescents with LBP with/without leg pain. Two hundred and fourteen children and adolescents, who were born between 2001 and 2009 and had lumbar spine MRI for LBP with/without leg pain, were evaluated in terms of intervertebral disc degeneration (IVDD), end-plates and paraspinal muscle changes on lumbar spine MRIs. Severe IVDD was detected at all lumbar levels except for L2-L3. Modic changes were present in 4.2% of the patients. Modic changes were more common in patients with severe IVDD than in those with mild-to-moderate IVDD. Severe IVDD was significantly associated with Modic changes at the corresponding L1-L2 and L3-L4 disc levels. Girls had significantly more fatty infiltration in the paraspinal muscles when compared to boys. The risk of having severe IVDD concomitant with Modic changes was high [odds ratio (OR), 8.6]. The OR was 20.7 for predicting the presence of severe IVDD at any level if Modic changes presented particularly at the L3-L4 level. The ORs of Modic changes presented at any lumbar level at the background of fat-infiltrated multifidus at L3-L4 and L4-L5 levels were 8.3 and 9.1, respectively. Fatty infiltration in the paraspinal muscles and IVDD were closely associated with Modic changes in children and adolescents with LBP. Lumbar IVDD in children and adolescents could be the result of a mechanical pathology.
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Intervertebral Disc
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Background: Recent studies have indicated the relation of vertebral endplate lesions (Modic changes) to low back pain (LBP). The aim of this study was to investigate the Modic changes in magnetic resonance imaging (MRI) of patients with low back pain, and its correlation with age, sex, type of changes, number of involved segments and location of changes. Additionally, association of degenerative disc changes and disc herniation was assessed. Methods: In this retrospective study, MRI records of 229 patients with LBP referring to Medical Center of Hazrat-e-Rasoul Hospital, Tehran, Iran, from August to February 2014, were assessed and Modic changes and degenerative and herniated disc changes were recorded. Results: Based on our observations, a significant association between Modic type and age (P= 0.003) existed in patients with LBP. The highest prevalence in Modic location were observed in anterior part of vertebral endplate (48.8, P= 0.001). Although, observation of the Modic changes in superior vertebral endplate was higher than inferior parts, but this differences was not statistically significant. The highest prevalence in degenerative disc disease was disc dehydration which was observed in 18.1 of patients (P= 0.04). The relationship between the degenerative changes and Modic type was significant (P= 0.04), while the most prevalent change of disc contour was disc bulging which occurred in 23.7 of patients (P= 0.01). The highest frequency of abnormal disc contour were observed in Modic type 2 which was statistically significant (P= 0.01). Modic surface involvement above 25 was significantly associated with disc herniation (P= 0.04). There was no significant association between Modic height involvement above 25 and disc herniation. Conclusion: Considering significant association between Modic changes and degenerative and herniated disc changes, reporting of Modic changes is necessary. © 2016, Tehran University of Medical Sciences. All rights reserved.
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Degenerative Disc Disease
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Modic changes
Disc herniation
Lumbar disc herniation
Intervertebral Disc Displacement
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Modic changes in the endplates of the vertebral bodies have been associated with low back pain. There is however paucity of information on the pattern of Modic changes in the lumbosacral spine in Nigerians with low back pain.To determine the prevalence of Modic changes in patients with chronic low back pain in our environment.Cross-sectional longitudinal study.University of Ilorin Teaching Hospital, Ilorin, Nigeria.A total of 147 consecutive adults who had MRI of the lumbosacral spine for chronic low back pain were examined for the presence of Modic changes.35(23.8%) individuals had Modic changes present out of I47 patients with low back pain evaluated.Out of the 735 lumbar vertebral endplates evaluated, 90(12.2%) had Modic changes present. Among the endplates with Modic changes, 36(40%) were type I, been the most common in our sample, while 27(30%) were type II and type III each.This study has shown that Modic changes occurred more frequently at the end plates of lower lumbar vertebrae(L4/L5, and L5/S1) and Type I was the most common while Type II and III had equal prevalence; the changes occurred more frequently with increasing age suggesting these changes are degenerative in nature.
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Nigerians
Lumbosacral joint
Back Pain
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