Abstract
PurposeTo evaluate the relationship between degenerative disc, endplate Modic changes (MC) type I, and pain during upright weight-bearing MRI scan of the lumbar spine in a cohort of patients with non-specific low back pain.Materials and methodsWe evaluated 38 patients with non-specific low back pain and MRI evidence of Modic I vertebral changes. The patients were evaluated in a standard and upright weight-bearing position using a dedicated MR unit. The extent of endplate MC type I, intervertebral disc height at the involved level, and degree of degeneration in the same intervertebral disc were compared. Pain was assessed through the VAS questionnaire.ResultsIn the upright position, the area of Modic I changes increased in 26 patients (68.4%, p ≤ 0.001) compared to the supine position. In the upright position, reduction in the disc height was found in 35 patients (92.1%). Correlation analysis showed moderate negative correlation (ρ = − 0.45) between intervertebral disc height and increase in the area of Modic I changes, and weak positive correlation (ρ = 0.12) between Pfirrmann grade and increase in the area of Modic I changes. At clinical evaluation, 30 patients (78.9%) reported worsening of low back pain standing in the upright position. Increase in VAS values on the upright position correlated significantly (ρ = 0.34) with an increase in the area of Modic I changes.ConclusionsOur results showed the modifications of Modic I changes under loading, with MRI evidence of increased MC area extent in the upright position and correlation between Modic changes extension increase and increase in pain in the standing position. Weight-bearing MRI scans represent a valuable complement to standard sequences since they provide the radiologist with additional diagnostic information about low back pain.Graphical abstractThese slides can be retrieved from Electronic Supplementary Material.
Highlights
IntroductionDegenerative disc disease of the spine causing low back pain is a leading cause of morbidity and chronic disability [1]
Degenerative disc disease of the spine causing low back pain is a leading cause of morbidity and chronic disability [1].MRI is the preferred imaging technique to evaluate the degenerative changes of the spine [2, 3], showing high sensitivity and specificity in the diagnosis of conditions like disc herniation, spinal stenosis, and spondylodiscitis [4,5,6,7]
In our study, evaluating standard supine and weight-bearing MR scans of 38 patients with nonspecific low back pain and MRI evidence of Modic I vertebral changes, we found Modic I changes extent increase in the upright position in 26 patients (68.4%). 30 patients (78.9%) reported worsening of low back pain standing in the upright position, with significant correlation between increase in VAS values on the upright position and the increase of Modic I changes extent (Á=0.34)
Summary
Degenerative disc disease of the spine causing low back pain is a leading cause of morbidity and chronic disability [1]. MRI is the preferred imaging technique to evaluate the degenerative changes of the spine [2, 3], showing high sensitivity and specificity in the diagnosis of conditions like disc herniation, spinal stenosis, and spondylodiscitis [4,5,6,7]. MRI signal changes in vertebral endplates, especially Modic changes (MC) type I, have been advocated to be a potential specific cause of low back pain [8, 9]. The exact pathophysiology of MC is still unclear, and the relationship between disc degeneration, endplates, and bone marrow has not been quantified, yet [7, 10, 11]. The role of biomechanical stress has been often advocated to explain the pathophysiology of Modic I changes
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
