Correlação entre as classificações de Pfirrmann e Modic na degeneração do disco intervertebral lombar Correlation between Pfirrmann and Modic classifications in the degeneration of lumbar intervertebral disc Correspondencia entre las clasificaciones de Pfirrmann y Modic en la degeneración del disco intervertebral lumbar
Marcio Squassoni LeiteRafael Paiva LucianoDélio Eulálio MartinsMarcelo WajchenbergEduardo Barros Puertas
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Objective: to correlate the changes found in the lumbar magnetic resonance imaging according to Modic and Pfirrmann classifications. Methods: lumbar spine resonances of 54 outpatients were selected (23 men and 31 women), who were already under investigation because of their comorbidity. According to their degree of Pfirrmann classification, 264 intervertebral discs (L1 to S1) were classified. The presence of signal abnormalities of the vertebral body was recorded as Modic classification. The χ 2 was applied, adopting significance levels below 0.05 (a=5%). Results: The mean age studied was of 48.4 years (26-77 years). A higher prevalence of Pfirrmann type IV (31.1%) was observed. In 88.3% of the sample, Modic was absent, and also Modic 3; 60% of Modic 2 was related to Pfirrmann type V, and 36.4% of ModicKeywords:
Modic changes
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A longitudinal follow-up of Modic changes on magnetic resonance imaging (MRI).To assess the prevalence and natural course Modic changes over a 3-year follow-up period.Modic changes are bone marrow and endplate lesions visible on MRI. To the authors' knowledge, no follow-up studies on their natural course have been published.The study population consisted of 60 unoperated sciatica patients 23 to 76 years of age. Baseline and 3-year lumbar MR images from L1-L2 through L5-S1 were analyzed independently by 2 radiologists and a consensus reading was performed.At baseline, the prevalence of Modic changes was 23%. Seven discs had mixed Type I/II, and 63 Type II change. Changes typically occurred at L4-L5 and L5-S1, and associated positively with age (P = 0.009). Ten of 70 discs (14%) with Modic changes at baseline displayed another type at 3 years. Furthermore, the nonconverted changes increased significantly in size. The incidence of new Modic changes during the follow-up was 6% (13 of 230).Modic changes are common MRI findings in patients with degenerative lumbar disc disease. We found evidence that Modic Type II changes may be less stable than previously assumed.
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Modic changes
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Degeneration (medical)
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To investigate a possible correlation between the histological and morphometric properties of herniated intervertebral disc, clinical and magnetic resonance imaging (MRI) characteristics of patients with lumbar disc degeneration (LDD).Thirty six patients with LDD were clinically evaluated using Japanese Orthopaedic Association Score (JOAS), visual analogue scale (VAS) for pain in the lower back or in the pelvic limb; MRI-based classification according to Pfirrmann and Modic criteria. All patients underwent decompressive surgery and herniated intervertebral disc samples were histologically and morphometrically analyzed. Data obtained were statistically analyzed for bivariate and partial correlations.The mean area size of chondron clusters correlated with age, JOAS (r=-0.385, p=0.032, tau=-0.279, rho=-0.380), Pfirrmann (r=0.505, p=0.002, tau=0.289, rho=0.365) and Modic (r=0.500, p=0.002, tau=0.331, rho=0.419) grading. There was a strong correlation between maximum area size of chondrons and JOAS (r=-0.427, p=0.009, tau=-0.299, rho=-0.430), Pfirrmann changes (r=0.432, p=0.008, tau=0.309, rho=0.388) and Modic endplate changes (r=0.444, p=0.007, tau=0.343, rho=0.434). JOAS correlated with both MRI classifications used for LDD.The intervertebral disc cells tend to aggregate in clusters and the size of the chondrons from LDD correlated with JOAS, Pfirrmann and Modic. JOAS correlates with the imagistic evaluation systems Pfirrmann and Modic.
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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.
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Modic changes
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Intervertebral Disc
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To evaluate the relationship between Modic change and disc height together with lumbar hyperosteogeny and study the role of Modic change in lumbar degeneration.The imaging data of 150 elderly patients with chronic low back pain were analysed retrospectively. All patients underwent MRI and lumbar lateral X-ray examination. The lumbar disc from L1-L2 to L5-S1 were selected for this study, including 750 discs, vertebral and endplate close to disc in 150 patients. The incidence rate of lumbar endplate Modic change, disc height and the degree of vertebral bone hyperplasia were recorded. The ratio of disc height/lumbar intervertebral disc height < 50% was defined as disc collapse. The patients were divided into 4 groups in the basis of imaging changes. Group A1:disc collapse without severe lumbar hyperosteogeny; Group A2: disc collapse with severe lumbar hyperosteogeny; Group B1: Neither disc collapse nor severe lumbar hyperosteogeny; Group B2: severe lumbar hyperosteogeny without disc collapse. The incidence rates of Modic change were compared between the 4 groups by χ(2) test. Finally, the influence of disc height and vertebral bone hyperplasia on the incidence rate of Modic change was analysed.Four groups of patients observed a total of 750 discs. The number of intervertebral discs in the group A1 was 208, the incidence rate was 54.3%. The number of intervertebral discs in the group A2 was 135, the incidence rate of group A2 was 34.8%. The number of intervertebral discs in the B1 group was 225, the incidence rate of group B1 was 16.9%. The number of intervertebral discs in the B2 group was 182, the incidence rate of group B2 was 29.7%. There was significant difference of lumbar endplate Modic change incidence rate among the 4 groups(χ(2) = 69.565, P < 0.05). The results of post hoc test showed that the incidence rate of Modic change in group A1 was higher than group A2, B1 and B2 (χ(2) = 12.524, 66.701 and 24.102, P < 0.00714). There was significant difference of Modic change incidence rate between group A2 and B1(χ(2) = 15.032, P < 0.00714), but there was no significant difference of Modic change incidence rate between group A2 and B2 (χ(2) = 0.945, P > 0.00714) . There was significant difference of Modic change incidence rate between group B2 and group B1 (χ(2) = 9.395, P < 0.00714).The incidence rate of Modic change with disc collapse but without severe lumbar hyperosteogeny is high in elderly patients with chronic low back pain. There is no significant difference of Modic change incidence between patients with both disc collapse and severe lumbar hyperosteogeny and patients with severe lumbar hyperosteogeny but without disc collapse.
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Objective To evaluate the distribution of Modic changes of endplate in lumber spondylolisthesis and its ralted factors.Methods The imaging data of 264 patients with lumber spondylolisthesis treated in our hospital from October 2005 to October 2011 were reviewed retrospectively.The incidence and the type of Modic changes was compared between isthmic spondylolisthesis and degenerative spondylolisthesis.The correlation between Modic changes and slipping degree of spondylolisthesis,disc degenerations,body mass index and physical activity were analyzed.Results Of all patients,113 patients diagnosed to be degenerative spondylolisthesis,7 patients(6.2%)were classified as type Ⅰ and 38 patients(33.6%) as type Ⅱ;and 151 patients diagnosed to be isthmic spondylolisthesis,12 patients(7.9%)were classified as type Ⅰ,23 patients(15.2%) as type Ⅱ,and 28 patients(18.5%)were classified as type Ⅲ.In the patients with lumber spondylolisthesis and Modic changes,the incidence rate of the Modic changes in the level of spondylolysis was more higher than the ones in the rest levels.Modic changes were significantly correlated with slipping degree of spondylolisthesis,disc degenerations,body mass index and physical activity(P0.05).Conclusion Modic changes correlate with slipping degree of spondylolisthesis,disc degenerations,body mass index and physical activity.In the isthmic spondylolisthesis,the most of Modic changes are type Ⅱ;and in the degenerative spondylolisthesis,Modic type Ⅲ changes predominate,and most of Modic change locate on the level of spondylolysis.
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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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