Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2011

Open Access 01-12-2011 | Research article

Is the presence of Modic changes associated with the outcomes of different treatments? A systematic critical review

Authors: Rikke K Jensen, Charlotte Leboeuf-Yde

Published in: BMC Musculoskeletal Disorders | Issue 1/2011

Login to get access

Abstract

Background

Modic changes (MCs) have been identified as a diagnostic subgroup associated with low back pain (LBP). The aetiology of MCs is still unknown and there is no effective treatment available. If MCs constitute a specific subgroup of LBP, it seems reasonable to expect different effects from different treatments. The objective of this systematic critical literature review was therefore to investigate if there is evidence in the literature that the presence of MCs at baseline is associated with a favourable outcome depending on the treatment provided for LBP.

Methods

The databases MEDLINE and EMBASE were searched for relevant articles from 1984 to December 2010. A checklist including items related to the research questions and quality of the articles was used for data extraction and quality assessment. Of the 1650 articles found, five (six studies) were included in this review but because the studies were so heterogeneous, the results have been reported separately for each study.

Results

The treatments studied were: lumbar epidural steroid injections (n = 1), lumbar intradiscal steroid injections (n = 2), lumbar disc replacement (n = 1), fusion surgery (n = 1) and exercise therapy (n = 1). One of the two studies investigating treatment with intradiscal steroid injections and the study investigating fusion surgery reported that MCs were positively associated with the outcomes of pain and disability. The other study on lumbar intradiscal steroid injections and the study on lumbar epidural steroid injections reported mixed results, whereas the study on lumbar disc replacement and the study on exercise therapy reported that MCs were not associated with the outcomes of pain and disability.

Conclusions

The available studies on the topic were too few and too heterogeneous to reach a definitive conclusion and it is therefore still unclear if MCs may be of clinical importance when guiding or prescribing the 'right' treatment for a patient with LBP.
Appendix
Available only for authorised users
Literature
1.
Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G: Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006, 15 (Suppl 2): S192-S300.CrossRefPubMedPubMedCentral
2.
van Tulder MW, Koes B, Malmivaara A: Outcome of non-invasive treatment modalities on back pain: an evidence-based review. Eur Spine J. 2006, 15 (Suppl 1): S64-S81.CrossRefPubMed
3.
Kjaer P, Korsholm L, Bendix T, Sorensen JS, Leboeuf-Yde C: Modic changes and their associations with clinical findings. Eur Spine J. 2006, 15: 1312-1319. 10.1007/s00586-006-0185-x.CrossRefPubMedPubMedCentral
4.
de Roos A, Kressel H, Spritzer C, Dalinka M: MR imaging of marrow changes adjacent to end plates in degenerative lumbar disk disease. AJR Am J Roentgenol. 1987, 149: 531-534.CrossRefPubMed
5.
Hajek PC, Baker LL, Goobar JE, Sartoris DJ, Hesselink JR, Haghighi P, Resnick D: Focal fat deposition in axial bone marrow: MR characteristics. Radiology. 1987, 162: 245-249.CrossRefPubMed
6.
Hayes CW, Jensen ME, Conway WF: Non-neoplastic lesions of vertebral bodies: findings in magnetic resonance imaging. Radiographics. 1989, 9: 883-903.CrossRefPubMed
7.
Lenz GP, Assheuer J, Lenz W, Gottschlich KW: New aspects of lumbar disc disease. MR imaging and histological findings. Arch Orthop Trauma Surg. 1990, 109: 75-82. 10.1007/BF00439383.CrossRefPubMed
8.
Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR: Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988, 166: 193-199.CrossRefPubMed
9.
Modic MT, Masaryk TJ, Ross JS, Carter JR: Imaging of degenerative disk disease. Radiology. 1988, 168: 177-186.CrossRefPubMed
10.
Jensen TS, Karppinen J, Sorensen JS, Niinimaki J, Leboeuf-Yde C: Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J. 2008, 17: 1407-1422. 10.1007/s00586-008-0770-2.CrossRefPubMedPubMedCentral
11.
Albert HB, Kjaer P, Jensen TS, Sorensen JS, Bendix T, Manniche C: Modic changes, possible causes and relation to low back pain. Med Hypotheses. 2008, 70: 361-368. 10.1016/j.mehy.2007.05.014.CrossRefPubMed
12.
Lusins JO, Cicoria AD, Goldsmith SJ: SPECT and lumbar MRI in back pain with emphasis on changes in end plates in association with disc degeneration. J Neuroimaging. 1998, 8: 78-82.CrossRefPubMed
13.
van Dieen JH, Weinans H, Toussaint HM: Fractures of the lumbar vertebral endplate in the etiology of low back pain: a hypothesis on the causative role of spinal compression in aspecific low back pain. Med Hypotheses. 1999, 53: 246-252. 10.1054/mehy.1998.0754.CrossRefPubMed
14.
Schmid G, Witteler A, Willburger R, Kuhnen C, Jergas M, Koester O: Lumbar disk herniation: correlation of histologic findings with marrow signal intensity changes in vertebral endplates at MR imaging. Radiology. 2004, 231: 352-358. 10.1148/radiol.2312021708.CrossRefPubMed
15.
Jensen TS, Kjaer P, Korsholm L, Bendix T, Sorensen JS, Manniche C, Leboeuf-Yde C: Predictors of new vertebral endplate signal (Modic) changes in the general population. Eur Spine J. 2010, 19: 129-135. 10.1007/s00586-009-1184-5.CrossRefPubMed
16.
17.
Stirling A, Worthington T, Rafiq M, Lambert PA, Elliott TS: Association between sciatica and Propionibacterium acnes. Lancet. 2001, 357: 2024-2025. 10.1016/S0140-6736(00)05109-6.CrossRefPubMed
18.
Carricajo A, Nuti C, Aubert E, Hatem O, Fonsale N, Mallaval FO, Vautrin AC, Brunon J, Aubert G: Propionibacterium acnes contamination in lumbar disc surgery. J Hosp Infect. 2007, 66: 275-277. 10.1016/j.jhin.2007.04.007.CrossRefPubMed
19.
Wedderkopp N, Thomsen K, Manniche C, Kolmos HJ, Secher JT, Leboeuf YC: No evidence for presence of bacteria in modic type I changes. Acta Radiol. 2009, 50: 65-70. 10.1080/02841850802524485.CrossRefPubMed
20.
Ohtori S, Koshi T, Yamashita M, Yamauchi K, Inoue G, Suzuki M, Takaso M, Orita S, Eguchi Y, Ochiai N, Kishida S, Kuniyoshi K, Nakamura J, Aoki Y, Ishikawa T, Arai G, Miyagi M, Kamoda H, Takahashi K: Existence of pyogenic spondylitis in Modic type 1 change without other signs of infection: 2-year follow-up. Eur Spine J. 2010
21.
Lang P, Chafetz N, Genant HK, Morris JM: Lumbar spinal fusion. Assessment of functional stability with magnetic resonance imaging. Spine (Phila Pa 1976). 1990, 15: 581-588. 10.1097/00007632-199006000-00028.CrossRef
22.
Chataigner H, Onimus M, Polette A: Surgery for degenerative lumbar disc disease. Should the black disc be grafted?. Rev Chir Orthop Reparatrice Appar Mot. 1998, 84: 583-589.PubMed
23.
Albert HB, Manniche C, Sorensen JS, Deleuran BW: Antibiotic treatment in patients with low-back pain associated with Modic changes Type 1 (bone oedema): a pilot study. Br J Sports Med. 2008, 42: 969-973.CrossRefPubMed
24.
Kleinstuck F, Dvorak J, Mannion AF: Are "structural abnormalities" on magnetic resonance imaging a contraindication to the successful conservative treatment of chronic nonspecific low back pain?. Spine (Phila Pa 1976). 2006, 31: 2250-2257. 10.1097/01.brs.0000232802.95773.89.CrossRef
25.
Buttermann GR: The effect of spinal steroid injections for degenerative disc disease. Spine J. 2004, 4: 495-505. 10.1016/j.spinee.2004.03.024.CrossRefPubMed
26.
Esposito P, Pinheiro-Franco JL, Froelich S, Maitrot D: Predictive value of MRI vertebral end-plate signal changes (Modic) on outcome of surgically treated degenerative disc disease: Results of a cohort study including 60 patients. Neurochirurgie. 2006, 52: 315-322. 10.1016/S0028-3770(06)71225-5.CrossRefPubMed
27.
Siepe CJ, Mayer HM, Wiechert K, Korge A: Clinical results of total lumbar disc replacement with ProDisc II: three-year results for different indications. Spine (Phila Pa 1976). 2006, 31: 1923-1932. 10.1097/01.brs.0000228780.06569.e8.CrossRef
28.
Fayad F, Lefevre-Colau M-M, Rannou F, Quintero N, Nys A, Mace Y, Poiraudeau S, Drape JL, Revel M: Relation of inflammatory modic changes to intradiscal steroid injection outcome in chronic low back pain. Eur Spine J. 2007, 16: 925-931. 10.1007/s00586-006-0301-y.CrossRefPubMedPubMedCentral
29.
Schulz KF, Altman DG, Moher D: CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. J Pharmacol Pharmacother. 2010, 1: 100-107. 10.4103/0976-500X.72352.CrossRefPubMedPubMedCentral
Metadata
Title
Is the presence of Modic changes associated with the outcomes of different treatments? A systematic critical review
Authors
Rikke K Jensen
Charlotte Leboeuf-Yde
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2011
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-12-183

Other articles of this Issue 1/2011

BMC Musculoskeletal Disorders 1/2011 Go to the issue

Study protocol

A hinged external fixator for complex elbow dislocations: A multicenter prospective cohort study

Research article

Profile and course of early rheumatoid arthritis in Morocco: a two-year follow-up study

Research article

Cross-cultural validation of the Educational Needs Assessment Tool in RA in 7 European countries

Research article

Microstructure and biomechanical characteristics of bone substitutes for trauma and orthopaedic surgery

Research article

Semiquantitative assessment of subchondral bone marrow edema-like lesions and subchondral cysts of the knee at 3T MRI: A comparison between intermediate-weighted fat-suppressed spin echo and Dual Echo Steady State sequences

Research article

Evidence for validity and reliability of a french version of the FAAM