Top

European Spine Journal

Published in:

01-03-2014 | Original Article

The evolution of degenerative marrow (Modic) changes in the cervical spine in neck pain patients

Authors: Eugen Mann, Cynthia K. Peterson, Jürg Hodler, Christian W. A. Pfirrmann

Published in: European Spine Journal | Issue 3/2014

Abstract

Purpose

To evaluate the natural course of end plate marrow (Modic) changes (MC) in the cervical spine on MRI scans of patients with neck pain. A few longitudinal studies have assessed the development of MC over time in the lumbar spine but only two recent studies evaluated MC in the cervical spine in asymptomatic volunteers and those with whiplash. Thus, this study now reports on the natural course of MC in the cervical spine in symptomatic patients.

Methods

From the cervical MRI scans of 426 neck pain patients (mean age 61.2 years), 64 patients had follow-up MRI studies. The prevalence and types of MC were retrospectively assessed on the follow-up scans and compared to the original MRI findings.

Results

With an average of 2.5 years between the two MRI scans, the prevalence of MC type 1 (MC1) noted at baseline (7.4 % or 19 motion segments) slightly increased (8.2 % or 21 segments) but the prevalence of MC2 (14.5 % or 37 segments) increased considerably (22.3 % or 57 segments). In addition, 14 new MC1 segments and 8 new MC2 segments were noted. Twelve segments with MC1 at baseline converted to MC2 at follow-up. No conversion from MC2 to MC1 or reverting to a normal image was observed.

Conclusions

MC in the cervical spine are a dynamic phenomenon similar to the lumbar spine.

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

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

Ross JS, Modic MT (1992) Current assessment of spinal degenerative disease with magnetic resonance imaging. Clin Orthop Relat Res 279:68–81PubMed

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. Skeletal Radiol 33:399–404. doi:10.1007/s00256-004-0780-z PubMedCrossRef

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 14:1574–1581. doi:10.1007/s00330-004-2314-4 PubMedCrossRef

Weishaupt D, Zanetti M, Hodler J, Boos N (1998) MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiology 209:661–666PubMed

Kerttula L, Luoma K, Vehmas T, Gronblad M, Kaapa E (2012) Modic type I change may predict rapid progressive, deforming disc degeneration: a prospective 1-year follow-up study. Eur Spine J 21:1135–1142. doi:10.1007/s00586-012-2147-9 PubMedCentralPubMedCrossRef

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 7:363–368PubMedCentralPubMedCrossRef

Kjaer P, Korsholm L, Bendix T, Sorensen JS, Leboeuf-Yde C (2006) Modic changes and their associations with clinical findings. Eur Spine J 15:1312–1319. doi:10.1007/s00586-006-0185-x PubMedCentralPubMedCrossRef

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 17:1407–1422. doi:10.1007/s00586-008-0770-2 PubMedCentralPubMedCrossRef

11.

Rahme R, Moussa R (2008) The modic vertebral endplate and marrow changes: pathologic significance and relation to low back pain and segmental instability of the lumbar spine. AJNR Am J Neuroradiol 29:838–842. doi:10.3174/ajnr.A0925 PubMedCrossRef

12.

Zhang YH, Zhao CQ, Jiang LS, Chen XD, Dai LY (2008) Modic changes: a systematic review of the literature. Eur Spine J 17:1289–1299. doi:10.1007/s00586-008-0758-y PubMedCentralPubMedCrossRef

13.

Kuisma M, Karppinen J, Niinimaki J, Ojala R, Haapea M, Heliovaara M, Korpelainen R, Taimela S, Natri A, Tervonen O (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) 32:1116–1122. doi:10.1097/01.brs.0000261561.12944.ff CrossRef

14.

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 10:81. doi:10.1186/1471-2474-10-81 PubMedCentralPubMedCrossRef

15.

Hutton MJ, Bayer JH, Powell JM (2011) Modic vertebral body changes: the natural history as assessed by consecutive magnetic resonance imaging. Spine (Phila Pa 1976) 36:2304–2307. doi:10.1097/BRS.0b013e31821604b6 CrossRef

16.

Peterson CK, Humphreys BK, Pringle TC (2007) Prevalence of Modic degenerative marrow changes in the cervical spine. J Manipulative Physiol Ther 30:5–10. doi:10.1016/j.jmpt.2006.11.013 PubMedCrossRef

17.

Mann E, Peterson CK, Hodler J (2011) Degenerative marrow (Modic) changes on cervical spine magnetic resonance imaging scans: prevalence, inter- and intra-examiner reliability and link to disc herniation. Spine (Phila Pa1976) 36:1081–1085. doi:10.1097/BRS.0b013e3181ef6a1e CrossRef

18.

Kuisma M, Karppinen J, Niinimaki J, Kurunlahti M, Haapea M, Vanharanta H, Tervonen O (2006) A three-year follow-up of lumbar spine endplate (Modic) changes. Spine (Phila Pa 1976) 31:1714–1718. doi:10.1097/01.brs.0000224167.18483.14 CrossRef

19.

Jensen RK, Leboeuf-Yde C, Wedderkopp N, Sorensen JS, Jensen TS, Manniche C (2012) Is the development of Modic changes associated with clinical symptoms? A 14-month cohort study with MRI. Eur Spine J. doi:10.1007/s00586-012-2309-9

20.

Keller A, Boyle E, Skog TA, Cassidy JD, Bautz-Holter E (2012) Are Modic changes prognostic for recovery in a cohort of patients with non-specific low back pain? Eur Spine J 21:418–424. doi:10.1007/s00586-011-1964-6 PubMedCentralPubMedCrossRef

21.

Albert HB, Manniche C (2007) Modic changes following lumbar disc herniation. Eur Spine J 16:977–982. doi:10.1007/s00586-007-0336-8 PubMedCentralPubMedCrossRef

22.

Elfering A, Semmer N, Birkhofer D, Zanetti M, Hodler J, Boos N (2002) Risk factors for lumbar disc degeneration: a 5-year prospective MRI study in asymptomatic individuals. Spine (Phila Pa 1976) 27:125–134CrossRef

23.

Matsumoto M, Okada E, Ichihara D, Chiba K, Toyama Y, Fujiwara H, Momoshima S, Nishiwaki Y, Takahata T (2012) Modic changes in the cervical spine: prospective 10-year follow-up study in asymptomatic subjects. J Bone Joint Surg Br 94:678–683. doi:10.1302/0301-620X.94B5.28519 PubMedCrossRef

24.

Matsumoto M, Ichihara D, Okada E et al (2012) Modic changes of the cervical spine in patients with whiplash injury: A prospective 11-year follow-up study. Injury. doi:10.1016/j.injury.2012.12.001

25.

Matsumoto M, Fujimura Y, Suzuki N, Nishi Y, Nakamura M, Yabe Y, Shiga H (1998) MRI of cervical intervertebral discs in asymptomatic subjects. J Bone Joint Surg Br 80:19–24PubMedCrossRef

26.

Okada E, Matsumoto M, Fujiwara H, Toyama Y (2011) Disc degeneration of cervical spine on MRI in patients with lumbar disc herniation: comparison study with asymptomatic volunteers. Eur Spine J 20(4):585–591PubMedCentralPubMedCrossRef

27.

Marchiori DM, Henderson CN (1996) A cross-sectional study correlating cervical radiographic degenerative findings to pain and disability. Spine (Phila Pa 1976) 21:2747–2751CrossRef

28.

Peterson C, Bolton J, Wood AR, Humphreys BK (2003) A cross-sectional study correlating degeneration of the cervical spine with disability and pain in United kingdom patients. Spine (Phila Pa 1976) 28:129–133. doi:10.1097/01.BRS.0000041579.18338.13 CrossRef

Title: The evolution of degenerative marrow (Modic) changes in the cervical spine in neck pain patients
Authors: Eugen Mann
Cynthia K. Peterson
Jürg Hodler
Christian W. A. Pfirrmann
Publication date: 01-03-2014
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 3/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-013-2882-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The evolution of degenerative marrow (Modic) changes in the cervical spine in neck pain patients

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2014

The relationship between spinopelvic parameters and clinical symptoms of severe isthmic spondylolisthesis: a prospective study of 64 patients

Using notochordal cells of developmental origin to stimulate nucleus pulposus cells and bone marrow stromal cells for intervertebral disc regeneration

Long-term result of vocal cord paralysis after anterior cervical disectomy

A SNP in the 5′UTR of GDF5 is associated with susceptibility to symptomatic lumbar disc herniation in the Chinese Han population

Hemivertebrae resection for unbalanced multiple hemivertebrae: is it worth it?

Letter to the Editor concerning “CT Morphology and Morphometry of the normal adult coccyx” [by Woon JT et al. (2013); Eur Spine J 22(4):863–870]