Abstract
The article presents a literature review on the Modic changes (MCs) in the vertebral endplates, which are frequently detected in patients with chronic low back pain. The etiology of MCs is unknown; however, there are three causes which are considered the most probable today: mechanical, infectious and biochemical. They share a common mechanism of pro-inflammatory molecule migration from the degenerative disk. A close association has been identified and described between the MCs and a non-specific chronic low back pain. Disc degeneration exerts a further stress on the endplates and produces microcracks, through which the inflammatory mediators enter the bone marrow and provoke the MCs. At present, there are no evidence-based treatment protocols for the MCs. A certain progress has been made with antibiotic therapy, injections of steroids and antiresorbents; the effectiveness of anti-TNF-α therapy is being explored. The sporadic reference data on our disposal indicate that patients with MCs and chronic low back pain, along with instability, who do not respond to a conservative treatment, may be referred for the surgical treatment to relieve pain and improve quality of life. However, not all of the presented methods of surgical treatment with chronic back pain are effective in patients with the Modic changes. The divergence of patient treatment outcomes presented by various sources indicates the need for a further research to understand the MC pathogenesis and develop pathogenetic approaches to the treatment of this pathology.
Highlights
The article presents a literature review on the Modic changes (MCs) in the vertebral endplates, which are frequently detected in patients with chronic low back pain
The chronic low back pain (CLBP) is generated by various anatomic structures: vertebral bodies, intervertebral discs (IVDs), facet joints, nerve radices, muscles and ligaments, due to the inflammatory or degenerative changes
With the Modic changes Type 2 (MCs2), the hyperintense signal is registered in the Т1 mode, the hyperintense signal is registered in the Т2 mode and hypointense signal is registered in the STIR mode (Fig.2)
Summary
The Modic changes Type 1 (MCs1) is characterized by a hypointense signal in the Т1 mode, hyperintense signal in the Т2 mode and hyperintense signal in the STIR mode (Fig.). With the Modic changes Type 2 (MCs2), the hyperintense signal is registered in the Т1 mode, the hyperintense signal is registered in the Т2 mode and hypointense signal is registered in the STIR mode (Fig.). The Modic changes Type 3 (MCs3) is characterized by the MRI-registered hypointense signal in the Т1 mode, hypointense signal in the Т2 mode and hypointense signal in the STIR mode (Fig.). All the three Modic change types constitute different stages of one pathological process. In a number of cases, the Modic changes Type 1 changes remain intact for a long time; in the rare cases this stage may be reversed. According to the metaanalysis data, the МСs prevalence in the CLBP patients accounts for 43 % and only 6 % subjects with MCs do not suffer from pain [12]
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