Abstract
Two decades following their description, the significance of Modic vertebral endplate and marrow changes remains a matter of debate. These changes are closely related to the normal degenerative process affecting the lumbar spine, and their prevalence increases with age. However, the exact pathogenesis underlying these changes and their relation to segmental instability of the lumbar spine and to low back pain remain unclear. In this paper, we review the literature relevant to this topic and discuss the currently available evidence regarding the pathologic and clinical significance of Modic changes.
Highlights
Degenerative vertebral endplate and subchondral bone marrow changes were first noted on MR imaging by de Roos et al in 1987.1 A formal classification was subsequently provided by Modic et al in 1988,2 based on a study of 474 patients, most of whom had chronic low back pain (LBP)
2 are instead interchangeable and equipotent in symptom-generating capacity. From this review, it appears that Modic changes are dynamic markers of the normal age-related degenerative process affecting the lumbar spine
Type 1 changes are likely to be inflammatory in origin and seem to be strongly associated with active low back symptoms and segmental instability, reflecting a state of active degeneration and biomechanical instability of the lumbar spine
Summary
The Modic Vertebral Endplate and Marrow Changes: Pathologic Significance and Relation to Low Back Pain and Segmental Instability of the Lumbar Spine. Degenerative vertebral endplate and subchondral bone marrow changes were first noted on MR imaging by de Roos et al in 1987.1 A formal classification was subsequently provided by Modic et al in 1988,2 based on a study of 474 patients, most of whom had chronic low back pain (LBP). These authors described 2 types of endplate and marrow changes: Type 1 changes (Fig 1) were hypointense on T1-weighted imaging (T1WI) and hyperintense on T2-weighted imaging (T2WI) and were shown to represent bone marrow edema and inflammation. In a study of 228 Finnish middle-aged male workers, Kuisma et al[13] found that Modic changes at L5-S1, especially type 1 changes and extensive lesions, were strongly associated with pain symptoms and LBP
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