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European Spine Journal

Published in:

01-11-2016 | Review Article

Pathobiology of Modic changes

Authors: Stefan Dudli, Aaron J. Fields, Dino Samartzis, Jaro Karppinen, Jeffrey C. Lotz

Published in: European Spine Journal | Issue 11/2016

Abstract

Purpose

Low back pain (LBP) is the most disabling condition worldwide. Although LBP relates to different spinal pathologies, vertebral bone marrow lesions visualized as Modic changes on MRI have a high specificity for discogenic LBP. This review summarizes the pathobiology of Modic changes and suggests a disease model.

Methods

Non-systematic literature review.

Results

Chemical and mechanical stimulation of nociceptors adjacent to damaged endplates are likely a source of pain. Modic changes are adjacent to a degenerated intervertebral disc and have three generally interconvertible types suggesting that the different Modic change types represent different stages of the same pathological process, which is characterized by inflammation, high bone turnover, and fibrosis. A disease model is suggested where disc/endplate damage and the persistence of an inflammatory stimulus (i.e., occult discitis or autoimmune response against disc material) create predisposing conditions. The risk to develop Modic changes likely depends on the inflammatory potential of the disc and the capacity of the bone marrow to respond to it. Bone marrow lesions in osteoarthritic knee joints share many characteristics with Modic changes adjacent to degenerated discs and suggest that damage-associated molecular patterns and marrow fat metabolism are important pathogenetic factors. There is no consensus on the ideal therapy. Non-surgical treatment approaches including intradiscal steroid injections, anti-TNF-α antibody, antibiotics, and bisphosphonates have some demonstrated efficacy in mostly non-replicated clinical studies in reducing Modic changes in the short term, but with unknown long-term benefits. New diagnostic tools and animal models are required to improve painful Modic change identification and classification, and to clarify the pathogenesis.

Conclusion

Modic changes are likely to be more than just a coincidental imaging finding in LBP patients and rather represent an underlying pathology that should be a target for therapy.

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Title: Pathobiology of Modic changes
Authors: Stefan Dudli
Aaron J. Fields
Dino Samartzis
Jaro Karppinen
Jeffrey C. Lotz
Publication date: 01-11-2016
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 11/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-016-4459-7

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Pathobiology of Modic changes

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

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Letter to the Editor concerning “Relationship between sedimentation sign and morphological grade in symptomatic lumbar spinal stenosis” (by Laudato PA, Kulik G, Schizas C (2015) Eur Spine J; 24(10):2264–2268)

Effects of total hip arthroplasty on spinal sagittal alignment and static balance: a prospective study on 28 patients

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