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European Spine Journal
Published in: European Spine Journal 8/2011

01-08-2011 | Original Article

The prevalence of MRI-defined spinal pathoanatomies and their association with Modic changes in individuals seeking care for low back pain

Authors: Hanne B. Albert, Andrew M. Briggs, Peter Kent, Andreas Byrhagen, Christian Hansen, Karina Kjaergaard

Published in: European Spine Journal | Issue 8/2011

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Abstract

Modic changes are of increasing interest, however their age and gender prevalence are not well described. To date, the associations between Modic changes and other common vertebral pathologies have only been described in small samples (n < 100). Our aim was, in a large dataset of people with low back pain, to (1) describe the prevalence of a range of spinal pathoanatomies, and (2) examine the association between Modic changes and stages of intervertebral disc (IVD) pathology. Common pathologies were coded from the lumbar spine MRIs from 4,233 consecutive people imaged while attending a publicly-funded secondary care outpatient facility in Denmark. Prevalence data were calculated by pathology and by vertebral level. Prevalence was also calculated by age and gender categories for Modic changes. The association between stages of IVD pathology (degeneration, bulge, herniation) and Modic changes at L4/5 and L5/S1 was expressed using prevalence ratios (PR) and 95% confidence intervals. The prevalence of Modic changes and IVD pathology were greater in L4/5 and L5/S1, compared with the upper lumbar spine. There was no significant gender difference in prevalence of Modic changes (p = 0.11). The prevalence of IVD disc pathology occurring concurrently with Modic changes ranged from 11.5 to 17.5% (Type 1), 8.5 to 12.7% (Type 2) and 17.1 to 25.6% (Type 1 and/or 2) while the prevalence occurring in the absence of Modic changes ranged from 0.5 to 6.3% (Type 1), 0.3 to 4.9 (Type 2), 0.8 to 9.7% (Type 1 and/or 2). The associated PR for IVD pathology occurring concurrently with Modic changes ranged from 1.8 to 29.2 (p < 0.05). The highest PR (29.2) was between degeneration and Modic changes, indicating that it is rare for Modic changes to occur without disc degeneration. Spinal pathoanatomy was common in this population, particularly IVD pathologies, and a consistent trend of a relatively greater prevalence in the lower lumbar spine was identified. Modic changes were more likely to be present among individuals with IVD pathology than without, which may implicate mechanical factors as being one aetiological pathway for Modic changes, although other hypotheses may equally explain this association.
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Literature
1.
Walker BF, Muller R, Grant WD (2004) Low back pain in Australian adults. Prevalence and associated disability. J Manip Physiol Ther 27(4):238–244CrossRef
2.
Jeffries LJ, Milanese SF, Grimmer-Somers KA (2007) Epidemiology of adolescent spinal pain. A systematic overview of the research literature. Spine 32(23):2630–2637PubMedCrossRef
3.
Waddell G (1987) 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain. Spine 12(7):632–644PubMedCrossRef
4.
Briggs AM, Jordan JE, Buchbinder R, Burnett AF, O’Sullivan PB, Chua JY, Osborne RH, Straker LM (2010) Health literacy and beliefs among a community cohort with and without chronic low back pain. Pain 150(2):275–283PubMedCrossRef
5.
Lurie JD, Doman DM, Spratt KF, Tosteson ANA, Weinstein JN (2009) Magnetic resonance imaging interpretation in patients with symptomatic lumbar spine disc herniations. Comparison of clinician and radiologist readings. Spine 34(7):701–705. doi:10.​1097/​BRS.​0b013e31819b390e​ PubMedCrossRef
6.
Arana E, Marti-Bonmati L, Vega M, Bautista D, Molla E, Costa S, Montijano R (2006) Relationship between low back pain, disability, MR imaging findings and health care provider. Skeletal Radiol 35(9):641–647PubMedCrossRef
7.
Borenstein DG, O’Mara JW Jr, Boden SD, Lauerman WC, Jacobson A, Platenberg C, Schellinger D, Wiesel SW (2001) The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects: a seven-year follow-up study. J Bone Joint Surg Am 83-A(9):1306–1311PubMed
8.
Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS (1994) Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 331(2):69–73PubMedCrossRef
9.
10.
Jensen TS, Karppinen J, Sorensen JS, Niinimaki J, Leboeuf-Yde C (2008) Vertebral endplate signal changes (modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J 17(11):1407–1422. doi:10.​1007/​s00586-008-0770-2 PubMedCrossRef
11.
Jensen TS, Kent P, Karppinen J, Sorensen JS, Niinimäki J, LeBoeuf-yde C (2011) Do vertebral endplate signal (modic) changes hurt? In: Conference proceedings from the 2010 annual general meeting of the Society for Back Pain Research, Odense, Denmark. Eur Spine J (in press)
12.
de Roos A, Kressel H, Spritzer C, Dalinka M (1987) MR imaging of marrow changes adjacent to end plates in degenerative lumbar disk disease. Am J Roentgenol 149(3):531–534
13.
Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166(1):193–199PubMed
14.
Bayer J, Hutton M, Sawant M, Sharp D (2004) Vertebral endplate changes: The natural history as assessed by consecutive magnetic resonance imaging. In: Conference proceedings of the international society for the study of the lumbar spine, Porto, Portugal, p 206
15.
16.
17.
Albert HB, Kjaer P, Jensen TS, Sorensen JS, Bendix T, Manniche C (2008) Modic changes, possible causes and relation to low back pain. Med Hypotheses 70(2):361–368PubMedCrossRef
18.
Grant JP, Oxland TR, Dvorak MF, Fisher CG (2002) The effects of bone density and disc degeneration on the structural property distributions in the lower lumbar vertebral endplates. J Orthop Res 20(5):1115–1120PubMedCrossRef
19.
Pollintine P, Dolan P, Tobias JH, Adams MA (2004) Intervertebral disc degeneration can lead to “stress-shielding” of the anterior vertebral body—a cause of osteoporotic vertebral fracture? Spine 29(7):774–782PubMedCrossRef
20.
Pollintine P, Przybyla AS, Dolan P, Adams MA (2004) Neural arch load-bearing in old and degenerated spines. J Biomech 37(2):197–204PubMedCrossRef
21.
Adams MA, Dolan P (1999) Mechanical and biological factors in disc degeneration. In: Paper presented at the third interdisciplinary world congress on low back and pelvic pain, Vienna, Austria
22.
Adams MA, Freeman BJ, Morrison HP, Nelson IW, Dolan P (2000) Mechanical initiation of intervertebral discs degeneration. Spine 25:1625–1636PubMedCrossRef
23.
Adams MA, McNally DS, Dolan P (1996) ‘Stress’ distributions inside intervertebral discs. The effects of age and degeneration. J Bone Joint Surg Br 78:965–972PubMedCrossRef
24.
Crock HV (1986) Internal disc disruption. A challenge to disc prolapse fifty years on. Spine 11(6):650–653PubMedCrossRef
25.
Baithwaite I, White J, Saifuddin A, Renton P, Taylor BA (1998) Vertebral end-plate (modic) changes on lumbar spine MRI: correlation with pain reproduction at lumbar discography. Eur Spine J 7:363–368CrossRef
26.
Carragee EJ, Alamin TF, Miller JL, Carragee JM (2005) Discographic, mri and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. Spine J 5(1):24–35PubMedCrossRef
27.
Jensen TS, Sorensen JS, Kjaer P (2007) Intra- and interobserver reproducibility of vertebral endplate signal (modic) changes in the lumbar spine: the nordic modic consensus group classification. Acta Radiol 48(7):748–754PubMedCrossRef
28.
Sorensen SJ, Kjaer P, Jensen TS, Andersen P (2006) Low field magnetic resonance imaging of the lumbar spine: reliability of qualitative evaluation of disc and muscle parameters. Acta Radiol 47:947–953CrossRef
29.
Paajanen H, Erkintalo M, Parkkola R, Salminen J, Kormano M (1997) Age-dependent correlation of low-back pain and lumbar disc regeneration. Arch Orthop Trauma Surg 116(1–2):106–107PubMedCrossRef
30.
Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW (1990) Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 72(3):403–408PubMed
31.
Toyone T, Takahashi K, Kitahara H et al (1994) Vertebral bone marrow changes in degenerative lumbar disc disease: an MRI study of 74 patients with low back pain. J Bone Joint Surg (Brit) 76:757–764
32.
33.
Briggs AM, Dieen JHv, Wrigley TV, Greig AM, Phillips B, Lo SK, Bennell KL (2007) Thoracic kyphosis affects spinal loads and trunk muscle force. Phys Therapy 87(5):595–607CrossRef
34.
35.
36.
Chung CB, Vande Berg BC, Tavernier T, Cotten A, Laredo JD, Vallee C, Malghem J (2004) End plate marrow changes in the asymptomatic lumbosacral spine: frequency, distribution and correlation with age and degenerative changes. Skelet Radiol 33(7):399–404. doi:10.​1007/​s00256-004-0780-z CrossRef
Metadata
Title
The prevalence of MRI-defined spinal pathoanatomies and their association with Modic changes in individuals seeking care for low back pain
Authors
Hanne B. Albert
Andrew M. Briggs
Peter Kent
Andreas Byrhagen
Christian Hansen
Karina Kjaergaard
Publication date
01-08-2011
Publisher
Springer-Verlag
Published in
European Spine Journal / Issue 8/2011
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-011-1794-6

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