Modic Changes
Definition and Introduction
Modic changes (MC) are subchondral vertebral bone marrow changes and are identifiable with magnetic resonance imaging (MRI). MC were first recorded in 1987-88 by Assheuer et al.5 and classified by de Roos and Modic et al.[1]
Pathological Process and Risk Factors
Modic changes (MC) are a dynamic phenomenon and their etiology is still in debate. Disc/end plate injury, occult discitis and autoimmune reactions appear to set off an inflammatory cascade, leading to their development.[2]
Risk Factors include: Male sex, older age, diabetes mellitus, genetic factors, smoking, obesity, spinal deformities eg scoliosis, higher occupational loads and Degenerative Disc Disease. There is no conclusive evidence on the causative role of MC in chronic low back pain (LBP) or any influence on the long term outcome in patients with LBP or lumbar disc herniations (LDH). Patients with MC have been reported to have less satisfactory outcome following conservative treatment or discectomy, although the evidence is still unclear.
Classification
Modic changes classification consists of 4 types[3]:
- Type 0 - normal disc and vertebral body appearance,
- Type I - presence of bone marrow edema within vertebral body and hyper-vascularization,
- Type II - fatty replacements of the red bone marrow within vertebral body.
- Type III - subchondral bone sclerosis.
Clinical Presentation
MC were found to be an independent predictor of intense and disabling low back pain episodes in women.[4]
The subgroup of LBP clients with MC seeking physiotherapy care may more often report:
- Constant and nocturnal pain
- Higher level of functional impairment
- Lack of improvement at week 4 or later since onset
- Failed exercise therapy attempts
Proposed risk factors for developing MC include:
Prevalence of MC in clinical population was reported as 18-62%[7]
Physical examination findings may not be useful for differentiating between clients with and without MC and characteristic of degenerative disk disease.
Diagnostic Procedures
MRI is the method of diagnosing MC, however x-ray imaging is helpful in differentiating from spondyloarthropathy.[7]
Clinical Implications
Conclusive evidence does not exists on the causative role of MC in chronic low back pain (LBP) or any influence on the long term prognosis for patients with LBP or lumbar disc herniations (LDH).
Those with with MC reportedly have less satisfactory outcome following conservative treatment or discectomy, although clear evidence not available.[2]
References
- ↑ Udby PM, Samartzis D, Carreon LY, Andersen MØ, Karppinen J, Modic M. A definition and clinical grading of Modic changes. Journal of Orthopaedic Research®. 2022 Feb;40(2):301-7.Available:https://onlinelibrary.wiley.com/doi/10.1002/jor.25240 (accessed 2.9.2024)
- ↑ 2.0 2.1 Viswanathan VK, Shetty AP, Rajasekaran S. Modic changes-An evidence-based, narrative review on its patho-physiology, clinical significance and role in chronic low back pain. Journal of clinical orthopaedics and trauma. 2020 Sep 1;11(5):761-9.Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452231/(accessed 2.9.2024)
- ↑ 3.0 3.1 Xia W, Liu C, Duan S, Xu S, Wang K, Zhu Z, Liu H. The influence of spinal-pelvic parameters on the prevalence of endplate Modic changes in degenerative thoracolumbar/lumbar kyphosis patients. PloS one. 2018 May 15;13(5):e0197470.
- ↑ Määttä JH, Wadge S, MacGregor A, Karppinen J, Williams FM. ISSLS prize winner: vertebral endplate (Modic) change is an independent risk factor for episodes of severe and disabling low back pain. Spine. 2015 Aug 1;40(15):1187-93.
- ↑ 5.0 5.1 5.2 Mok FP, Samartzis D, Karppinen J, Fong DY, Luk KD, Cheung KM. Modic changes of the lumbar spine: prevalence, risk factors, and association with disc degeneration and low back pain in a large-scale population-based cohort. The Spine Journal. 2016 Jan 1;16(1):32-41.
- ↑ Määttä JH, Wadge S, MacGregor A, Karppinen J, Williams FM. ISSLS prize winner: vertebral endplate (Modic) change is an independent risk factor for episodes of severe and disabling low back pain. Spine. 2015 Aug 1;40(15):1187-93.
- ↑ 7.0 7.1 Zhang YH, Zhao CQ, Jiang LS, Chen XD, Dai LY. Modic changes: a systematic review of the literature. European Spine Journal. 2008 Oct 1;17(10):1289-99.