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European Spine Journal

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01-11-2012 | Original Article

Is the development of Modic changes associated with clinical symptoms? A 14-month cohort study with MRI

Authors: Rikke K. Jensen, Charlotte Leboeuf-Yde, Niels Wedderkopp, Joan S. Sorensen, Tue S. Jensen, Claus Manniche

Published in: European Spine Journal | Issue 11/2012

Abstract

Purpose

Modic changes (MCs) have been suggested to be a diagnostic subgroup of low back pain (LBP). However, the clinical implications of MCs remain unclear. For this reason, the aims of this study were to investigate how MCs developed over a 14-month period and if changes in the size and/or the pathological type of MCs were associated with changes in clinical symptoms in a cohort of patients with persistent LBP and MCs.

Methods

Information on LBP intensity and detailed information from MRI on the presence, type and size of MCs was collected at baseline and follow-up. Changes in type (Type I, II, III and mixed types) and size of MCs were quantified at both time points according to a standardised evaluation protocol. The associations between change in type, change in size and change in LBP intensity were calculated using odds ratios (ORs).

Results

Approximately 40 % of the MCs followed the expected developmental path from Type I (here Type I or I/II) to Type II (here Type II or II/III) or Type I to Type I/II. In general, the bigger the size of the MC at baseline, the more likely it was that it remained unchanged in size after 14 months. Patients who had MC Type I at both baseline and 14-month follow-up were less likely to experience an improvement in their LBP intensity as compared to patients who did not have Type I changes at both time points (OR 7.2, CI 1.3–37). There was no association between change in size of MCs Type I and change in LBP intensity.

Conclusions

The presence of MCs Type I at both baseline and follow-up is associated with a poor outcome in patients with persistent LBP and MCs.

Albert HB, Manniche C (2007) Modic changes following lumbar disc herniation. Eur Spine J 16:977–982PubMedCrossRef

Arana E, Kovacs FM, Royuela A, Estremera A, Asenjo B, Sarasibar H et al (2011) Modic changes and associated features in Southern European chronic low back pain patients. Spine J 11:402–411PubMedCrossRef

Braithwaite 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 7:363–368PubMedCrossRef

Bram J, Zanetti M, Min K, Hodler J (1998) MR abnormalities of the intervertebral disks and adjacent bone marrow as predictors of segmental instability of the lumbar spine. Acta Radiol 39:18–23PubMed

Brooks R (1996) EuroQol: the current state of play. Health Policy 37:53–72PubMedCrossRef

Childs JD, Piva SR, Fritz JM (2005) Responsiveness of the numeric pain rating scale in patients with low back pain. Spine (Phila Pa 1976) 30:1331–1334CrossRef

Chung CB, Vande Berg BC, Tavernier T, Cotten A, Laredo JD, Vallee C et al (2004) End plate marrow changes in the asymptomatic lumbosacral spine: frequency, distribution and correlation with age and degenerative changes. Skeletal Radiol 33:399–404PubMedCrossRef

de Roos A, Kressel H, Spritzer C, Dalinka M (1987) MR imaging of marrow changes adjacent to end plates in degenerative lumbar disk disease. AJR Am J Roentgenol 149:531–534PubMed

Jensen TS, Bendix T, Sorensen JS, Manniche C, Korsholm L, Kjaer P (2009) Characteristics and natural course of vertebral endplate signal (Modic) changes in the Danish general population. BMC Musculoskelet Disord 10:81PubMedCrossRef

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 17:1407–1422PubMedCrossRef

11.

Jensen RK, Leboeuf-Yde C, Wedderkopp N, Sorensen JS, Manniche C (2012) Rest versus exercise as treatment for patients with low back pain and Modic changes. A randomised controlled clinical trial. BMC Med 10(1):22

12.

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 48:748–754PubMedCrossRef

13.

Karchevsky M, Schweitzer ME, Carrino JA, Zoga A, Montgomery D, Parker L (2005) Reactive endplate marrow changes: a systematic morphologic and epidemiologic evaluation. Skeletal Radiol 34:125–129PubMedCrossRef

14.

Kjaer P, Korsholm L, Bendix T, Sorensen JS, Leboeuf-Yde C (2006) Modic changes and their associations with clinical findings. Eur Spine J 15:1312–1319PubMedCrossRef

15.

Kjaer P, Leboeuf-Yde C, Korsholm L, Sorensen JS, Bendix T (2005) Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year-old men and women. Spine (Phila Pa 1976) 30:1173–1180CrossRef

16.

Kleinstuck F, Dvorak J, Mannion AF (2006) Are “structural abnormalities” on magnetic resonance imaging a contraindication to the successful conservative treatment of chronic nonspecific low back pain? Spine 31:2250–2257PubMedCrossRef

17.

Kuisma M, Karppinen J, Haapea M, Lammentausta E, Niinimaki J, Tervonen O (2009) Modic changes in vertebral endplates: a comparison of MR imaging and multislice CT. Skeletal Radiol 38:141–147PubMedCrossRef

18.

Kuisma M, Karppinen J, Niinimaki J, Kurunlahti M, Haapea M, Vanharanta H et al (2006) A three-year follow-up of lumbar spine endplate (Modic) changes. Spine (Phila Pa 1976) 31:1714–1718CrossRef

19.

Kuisma M, Karppinen J, Niinimaki J, Ojala R, Haapea M, Heliovaara M (2007) Modic changes in endplates of lumbar vertebral bodies: prevalence and association with low back and sciatic pain among middle-aged male workers. Spine (Phila Pa 1976) 32:1116–1122CrossRef

20.

Lei D, Rege A, Koti M, Smith FW, Wardlaw D (2008) Painful disc lesion: can modern biplanar magnetic resonance imaging replace discography? J Spinal Disord Tech 21:430–435PubMedCrossRef

21.

Lim CH, Jee WH, Son BC, Kim DH, Ha KY, Park CK (2005) Discogenic lumbar pain: association with MR imaging and CT discography. Eur J Radiol 54:431–437PubMedCrossRef

22.

Luoma K, Vehmas T, Gronblad M, Kerttula L, Kaapa E (2008) MRI follow-up of subchondral signal abnormalities in a selected group of chronic low back pain patients. Eur Spine J 17:1300–1308PubMedCrossRef

23.

Mitra D, Cassar-Pullicino VN, McCall IW (2004) Longitudinal study of vertebral type-1 end-plate changes on MR of the lumbar spine. Eur Radiol 14:1574–1581PubMedCrossRef

24.

Modic MT, Masaryk TJ, Ross JS, Carter JR (1988) Imaging of degenerative disk disease. Radiology 168:177–186PubMed

25.

Modic MT, Ross JS (2007) Lumbar degenerative disk disease. Radiology 245:43–61PubMedCrossRef

26.

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 166:193–199PubMed

27.

O’Neill C, Kurgansky M, Kaiser J, Lau W (2008) Accuracy of MRI for diagnosis of discogenic pain. Pain Physician 11:311–326PubMed

28.

Ohtori S, Inoue G, Ito T, Koshi T, Ozawa T, Doya H et al (2006) Tumor necrosis factor-immunoreactive cells and PGP 9.5-immunoreactive nerve fibers in vertebral endplates of patients with discogenic low back Pain and Modic Type 1 or Type 2 changes on MRI. Spine (Phila Pa 1976) 31:1026–1031CrossRef

29.

Patrick DL, Deyo RA, Atlas SJ, Singer DE, Chapin A, Keller RB (1995) Assessing health-related quality of life in patients with sciatica. Spine (Phila Pa 1976) 20:1899–1908CrossRef

30.

Rabin R, de CF (2001) EQ-5D: a measure of health status from the EuroQol Group. Ann Med 33:337–343PubMedCrossRef

31.

The EuroQol Group (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16:199–208CrossRef

32.

Thompson KJ, Dagher AP, Eckel TS, Clark M, Reinig JW (2009) Modic changes on MR images as studied with provocative diskography: clinical relevance–a retrospective study of 2457 disks. Radiology 250:849–855PubMedCrossRef

33.

Williamson A, Hoggart B (2005) Pain: a review of three commonly used pain rating scales. J Clin Nurs 14:798–804PubMedCrossRef

Title: Is the development of Modic changes associated with clinical symptoms? A 14-month cohort study with MRI
Authors: Rikke K. Jensen
Charlotte Leboeuf-Yde
Niels Wedderkopp
Joan S. Sorensen
Tue S. Jensen
Claus Manniche
Publication date: 01-11-2012
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue 11/2012
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-012-2309-9

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Is the development of Modic changes associated with clinical symptoms? A 14-month cohort study with MRI

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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