Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P44. Long-term follow-up of patients with Modic changes

Abstract

BACKGROUND CONTEXT Back pain is the leading global cause of disability. Some studies have shown that Modic changes (MC) are strongly associated with low back pain (LBP) compared to disc degeneration alone. However, the long-term consequences in terms of patient-reported outcomes (PROs) have not been reported. This study evaluated if MC is associated with long-term disability and pain. PURPOSE The purpose of this study is to evaluate if patients with Modic changes have worse long-term outcomes compared to patients without. STUDY DESIGN/SETTING Longitudinal prospective follow-up study of a consecutive cohort of patients with chronic low back pain PATIENT SAMPLE A total of 207 patients with chronic low back pain. OUTCOME MEASURES Back- and leg pain (0–10), Roland-Morris Disability Questionnaire (RMDQ) and inflammatory pain pattern (IPP). METHODS In 2002, 207 patients with chronic low back pain were enrolled in an RCT comparing cognitive training with physical therapy. Inclusion criteria were age 18-60, almost daily LBP of ≥4 for more than four months in the past year. In 2017, these patients were then asked to complete the same PROs collected at baseline: back and leg pain (0–10), Roland-Morris Disability Questionnaire (RMDQ) and Inflammatory painpattern (IPP). Patients were then stratified based on the presence or absence of MC on their initial low-Tesla MRI. RESULTS Of the 204 cases with MRIs in 2002, 82 (40%) had MC in a least one lumbar segment. In 2017, 167 cases (82%) were available for follow-up including 65 (39%) with MC. There were no differences in demographics, smoking status, back- or leg-pain, or IPP scores at baseline and at 13-year follow-up between patients with and without MC. RMDQ was similar in both groups at baseline but worse in patients without MC at follow-up. CONCLUSIONS Various population-based studies have shown that a higher fraction of people with MC have LBP than those without. However, the current study showed that even patients without MC who had pain and were referred to a back clinic have the same clinical presentation as patients with MC. Patients with MC thus seemed to fare similar to patients without MC. However, LBP patients with MC had less long-term disability compared to LBP patients without.