Association between types of Modic changes in the lumbar region and low back pain in a large cohort: the Wakayama spine study

Abstract

The clinical significance of Modic changes in low back pain (LBP) is yet to be clarified. Thus, this study aimed to examine the association between Modic changes and LBP after adjustment for confounding factors. We evaluated participants in the second Wakayama Spine Study. The degree of endplate changes as measured using magnetic resonance imaging was classified based on the Modic classification system. The prevalence of the types of Modic change in the lumbar region and at each level was assessed. Multivariate logistic regression analysis was conducted to determine the association between the types of Modic changes and LBP with adjustment for age, sex, body mass index, disc degeneration score, and disc displacement score. The LBP intensity was also compared according to the Visual Analogue Scale (VAS) score among the three types of Modic change. Overall, 814 subjects were evaluated. Type II Modic changes were the most prevalent (41.9%). Only type I Modic changes were significantly associated with LBP (odds ratio): 1.84, 95% confidence interval [CI]: 1.1-2.9). The LBP VAS score was significantly higher in subjects with type I Modic change than that in those with no Modic change (23.9 ± 26.3 vs. 9.9 ± 19.4, p < 0.05). Type I Modic changes in the lumbar region are significantly associated with LBP. Profiling Modic changes may be helpful to improve targeted treatment of LBP.