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European Spine Journal
Published in: European Spine Journal 9/2015

Open Access 01-09-2015 | Original Article

Modic (endplate) changes in the lumbar spine: bone micro-architecture and remodelling

Authors: Egon Perilli, Ian H. Parkinson, Le-Hoa Truong, Kuan C. Chong, Nicola L. Fazzalari, Orso L. Osti

Published in: European Spine Journal | Issue 9/2015

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Abstract

Purpose

In the literature, inter-vertebral MRI signal intensity changes (Modic changes) were associated with corresponding histological observations on endplate biopsies. However, tissue-level studies were limited. No quantitative histomorphometric study on bone biopsies has yet been conducted for Modic changes. The aim of this study was to characterise the bone micro-architectural parameters and bone remodelling indices associated with Modic changes.

Methods

Forty patients suffering from disabling low back pain, undergoing elective spinal surgery, and exhibiting Modic changes on MRI (Modic 1, n = 9; Modic 2, n = 25; Modic 3, n = 6), had a transpedicular vertebral body biopsy taken of subchondral bone. Biopsies were first examined by micro-CT, for 3D morphometric analysis of bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular separation, trabecular number, and structure model index. Then, samples underwent histological analysis, for determination of bone remodelling indices: osteoid surface to bone surface ratio (OS/BS), eroded surface to bone surface (ES/BS) and osteoid surface to eroded surface ratio (OS/ES).

Results

Micro-CT analysis revealed significantly higher BV/TV (up to 70 % increase, p < 0.01) and Tb.Th (up to +57 %, p < 0.01) in Modic 3 biopsies, compared to Modic 1 and 2. Histological analysis showed significantly lower OS/BS in Modic 2 biopsies (more than 28 % decrease, p < 0.05) compared to 1 and 3. ES/BS progressively decreased from Modic 1 to 2 to 3, whereas OS/ES progressively increased with significantly higher values in Modic 3 (up to 159 % increase, p < 0.05) than in Modic 1 and 2.

Conclusions

Significant differences were found in bone micro-architectural parameters and remodelling indices among Modic types. Modic 1 biopsies had evidence of highest bone turnover, possibly due to an inflammatory process; Modic 2 biopsies were consistent with a reduced bone formation/remodelling stage; Modic 3 biopsies suggested a more stable sclerotic phase, with significantly increased BV/TV and Tb.Th compared to Modic 1 and 2, linked to increased bone formation and reduced resorption.
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Metadata
Title
Modic (endplate) changes in the lumbar spine: bone micro-architecture and remodelling
Authors
Egon Perilli
Ian H. Parkinson
Le-Hoa Truong
Kuan C. Chong
Nicola L. Fazzalari
Orso L. Osti
Publication date
01-09-2015
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 9/2015
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-014-3455-z

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