Abstract
BackgroundThe association of Modic changes (MC) with low back pain (LBP) is unclear. The purpose of our study was to investigate the associations between the extent of Type 1 (M1) and Type 2 (M2) MC and low back symptoms over a two-year period.MethodsThe subjects (n = 64, mean age 43.8 y; 55 [86%] women) were consecutive chronic LBP patients who had M1 or mixed M1/M2 on lumbar spine magnetic resonance imaging (MRI). Size and type of MC on sagittal lumbar MRI and clinical data regarding low back symptoms were recorded at baseline and two-year follow-up. The size (%) of each MC in relation to vertebral size was estimated from sagittal slices (midsagittal and left and right quarter), while proportions of M1 and M2 within the MC were evaluated from three separate slices covering the MC. The extent (%) of M1 and M2 was calculated as a product of the size of MC and the proportions of M1 and M2 within the MC, respectively. Changes in the extent of M1 and M2 were analysed for associations with changes in LBP intensity and the Oswestry disability index (ODI), using linear regression analysis.ResultsAt baseline, the mean LBP intensity was 6.5 and the mean ODI was 33%. During follow-up, LBP intensity increased in 15 patients and decreased in 41, while ODI increased in 19 patients and decreased in 44. In univariate analyses, change in the extent of M1 associated significantly positively with changes in LBP intensity and ODI (beta 0.26, p = 0.036 and beta 0.30, p = 0.017; respectively), whereas the change in the extent of M2 did not associate with changes in LBP intensity and ODI (beta -0.24, p = 0.054 and beta -0.13, p = 0.306; respectively). After adjustment for age, gender, and size of MC at baseline, change in the extent of M1 remained significantly positively associated with change in ODI (beta 0.53, p = 0.003).ConclusionChange in the extent of M1 associated positively with changes in low back symptoms.
Highlights
The association of Modic changes (MC) with low back pain (LBP) is unclear
Modic changes (MC) are vertebral subchondral bone marrow changes that are visible in magnetic resonance imaging (MRI)
Study population The study population was selected from consecutive LBP patients (n = 4380) with or without radicular symptoms who were referred initially for standard lumbar spine MRI to the Departments of Orthopaedics, Rheumatology or Physical and Rehabilitation Medicine at the region of Helsinki University Hospital during 2003–2007
Summary
The association of Modic changes (MC) with low back pain (LBP) is unclear. Modic changes (MC) are vertebral subchondral bone marrow changes that are visible in magnetic resonance imaging (MRI). They are strongly associated with degenerative disc disease [1]. MC, especially Type 1 MC (M1), have been correlated with low back pain (LBP) in both population-based and clinical samples [2,3,4,5,6]. M1 is thought to represent acute inflammatory changes in degenerative disc disease, on the basis of fibrovascular replacement in histopathological specimens of subchondral bone marrow [1,2]. Type 2 MC (M2) shows increased signal intensity on both T1w and T2w, and it appears as yellow
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