Endplate Changes Research Articles

Lumbar vertebral T2-relaxation time investigated with T2-mapping at multiple time points in a day demonstrate large individual variations.

PURPOSE The increasing interest of endplate and Modic changes as potential pain generators in low back pain (LBP), along with advancement of functional quantitative magnetic resonance imaging (MRI) techniques, makes it important to characterize the vertebral dynamic behavior in detail. This study aims to perform characterization of the dynamic behavior of the vertebral bodies (VB) by investigating the VB diurnal variation in T2-relaxation time in a cross-sectional asymptomatic group of individuals. METHODS T2-mapping of 30 VBs (L1-L5) in six healthy volunteers (mean age, 40 years; range, 29-65 years) was performed with a 1.5 Tesla MRI at three time points over the day (7 am, 12 am, 5 pm). Volumetric regions of interest were segmented manually to determine VB T2-relaxation time, which was compared between the three time points. RESULTS On a group level only small and not significant diurnal VB variation was detected (all P >.10), with median T2 (ms) (quartiles; Q1, Q3) at the three time points 88.7 (84.1, 99.1), 87.3 (85.0, 96.1) and 87.8 (84.4, 99.2). However, in some VBs up to 7% increase respectively 9% decrease in T2-relaxation time was found during the day. Further, there was a relatively large variation between the individuals in absolute VB T2-relaxation times (range 73.2-108.3 ms), but small differences between the VBs within an individual. CONCLUSION This first T2-mapping study of the VB signal dynamics, in repeated investigations during one day, display variation in T2-relaxation time in specific individual VBs but were negligible on a group level. The result may be of importance when evaluating patients with spinal pathologies and suggest further examinations of dynamic changes not only of the disc but also vertebrae.

Vertebral end-plate changes

Background: Our aim was to assess the relationship between postoperative recurrent low back pain and vertebral body end-plate signal intensity changes on magnetic resonance imaging in disc herniation patients. Materials and Methods: The preoperative magnetic resonance images of 748 patients were retrospectively reviewed. End-plate changes were separated into three groups according to the Modic classification. The postoperative clinical improvement was defined according to the Kawabata criteria. The localization and type of end-plate degeneration and improvement after the operation were analyzed with Pearson's Chi-square test. Results: End-plate degeneration was found in 394 of 748 patients. Single-level and multiple-level end-plate changes were present in 70.4% and 29.6% of the patients, respectively. Type 2 (85.5%), type 1 (10.7%), and type 3 (3.8%) degenerations were encountered in order of frequency. The severities of the end-plate changes were mild, moderate, and severe in 63.2%, 32.7%, and 4.1% of the patients. Type 1 and type 2 degenerations correlated with clinical course in the postoperative period (P < 0.05). Conclusions: Type 1 and type 2 degenerative end-plate changes seen on preoperative magnetic resonance scans can influence the clinical course and be an indicator of postoperative back pain.

Imaging and evaluation of low backache using Magnetic Resonance Imaging: An observational cross-sectional study

Low backache is one of the most common reasons for outpatient visits and results from variety of causes. Persistent backache not responding to conservative therapy requires immediate evaluation and MRI has evolved as the modality of choice to know the cause and plan the management. The objective is to categorize the spinal causes of low backache using MRI. This study was done among 100 patients referred from various departments for MRI spine after taking proper consent in age group of 18-80 years over a period of one year. Out of 100 patients, majority belonged to 45-54 years age group with male: female ratio of 1.2:1. L4-L5 disc was affected most in this study. Degenerative disease-seen in 89% of total cases, disc bulge (89%), disc dessication (73%), disc herniation (28%), annular tear (27%). end plate changes (46%), marginal osteophytes (64%), Schmorl’s nodes (29%), acute compression fracture (2%), pars interarticularis fracture (15%) ligament flavum hypertrophy (52%), facet joint arthropathy (7%), lumbar canal stenosis (21%), and nerve root compression (76%). Congenital causes- seen in 24% of total cases in the form of lumbosacral transition anomalies, spina bifida, scoliosis, perineural cysts, limbus vertebra and fusion anomalies. Infective spondylodiscitis- seen in 14% of total cases, commonly involving 25-34 year age group and D11-12 level. Spinal neoplasms- seen in 8% of total cases, commonly involved 45-54 year age group. Metastasis more common than primary spinal neoplasms. It can be concluded from this study that MRI is an accurate radiation free modality for evaluation of low back pain.

Experimental Investigation of the Secondary Changes in Imaging After Lumbar Disc Nucleoplasty in Rabbits.

To explore the changes in imaging after lumbar disc nucleoplasty in rabbits. Twenty-four rabbits were randomly selected for X-ray, computerized tomography (CT), and magnetic resonance imaging (MRI) at 2, 6, and 12 weeks post operation. Moreover, their L3/4, L4/5, and L5/6 intervertebral discs were randomly selected as the untreated, annulus puncture, and nucleoplasty groups, respectively. Changes in disc height index (DHI%) and MRI grade were measured and compared. CT three-dimensional reconstruction was used to evaluate adjacent bone endplate changes. The untreated group's DHI% decreased slightly at different time points (p > 0.05), while that of the nucleoplasty and annulus puncture groups decreased progressively (p < 0.05). At six weeks post operation, the nucleoplasty group's DHI% was significantly lower than that of the annulus puncture group (p < 0.05), with mild osteosclerosis and local rough changes in the endplate. At 12 weeks post operation, a "bone bridge" connection was observed in the nucleoplasty group. There was no significant difference in MRI grade between the untreated and annulus puncture groups at different time points (p > 0.05). MRI grades of the intervertebral disc in the nucleoplasty and annulus puncture groups showed a progressive increase (p < 0.05). Compared with the annulus puncture at the same time point, the nucleoplasty group's MRI grade of the intervertebral disc was significantly higher (p < 0.05). Thus, damage caused by an annulus puncture can lead to progressive degeneration of the lumbar disc. Nucleoplasty may have a cumulative effect with the injury of the annulus puncture. Clinicians need to comprehensively consider advantages and disadvantages of nucleoplasty, strictly grasp indications of treatment, and prevent longterm complications.

Exploring macrophage differentiation and its relation to Modic changes in human herniated disc tissue

IntroductionCervical- and lumbosacral radiculopathy symptoms due to disc herniation are likely to be influenced by macrophage infiltration of the herniated disc. Vertebral endplate changes are hypothesized to, at least partially, correlate to the inflammatory condition of the disc and its environment. Research questionThe present study aims to evaluate several immunohistochemical M1-and M2-markers for their suitability to discern pro-inflammatory M1-and anti-inflammatory M2 macrophage differentiation patterns in herniated intervertebral disc tissue. In addition, their associations with Modic changes (MC) of the vertebral endplates will be evaluated. Materials and methodsHerniated disc samples were collected from 45 patients undergoing surgery for cervical- or lumbosacral radiculopathy. Samples were processed for immunohistochemistry and stained for the presence of macrophages: CD68 (macrophage marker), CD40 (M1), iNOS (M1), CD192 (M1), CD163 (M2), Arg1 (M2) and CD209 (M2). T-cells (CD3) and neutrophil (CD15) expressions were studied additionally. ResultsCD68 positive cells were present with a median density of 50/cm2, M2 markers CD163 and CD209 were expressed most dominantly, followed by M1 marker CD192. Other M1/M2 markers, T-cell and neutrophil expression was limited. Lumbar samples showed higher expression of iNOS and Arg1 compared to cervical samples. Presence of Modic changes was associated with higher levels of CD68+ cells (p ​= ​0.046), but no significant differences in M1/M2 markers were found. Discussion and conclusionFor studying M1 macrophages, CD192 is the most suitable marker due to its high expression; whereas for M2 macrophages, this is CD163 due to its high expression and selectivity. Further, the relatively high expression of M2 markers indicates predominance of anti-inflammatory over pro-inflammatory macrophages in symptomatic lumbar and cervical disc herniations. No associations between M1/M2 markers and MC were seen in this limited number of samples. In order to further explore the role of macrophage differentiation and its relation with MC in radiculopathy, a large prospective trial with elaborate clinical follow-up is required.

Bipedicular Basi-Vertebral Nerve Ablation: A Case Report

Introduction Intraosseous ablation of the basivertebral nerve (BVNA) is an emerging minimally invasive treatment to relieve chronic mechanical axial low back pain associated with Modic type 1 or type 2 vertebral end-plate changes. Randomized controlled trials demonstrate improvements in pain and function sustained for up to five-years. Methods A 40-year-old woman presented with an eight-year history of central low back with mechanical features. There was minimal response to active physical reconditioning techniques, breast reduction surgery and chronic opioid prescription. Imaging disclosed modic type 1 vertebral end-plate changes at the L5/S1 segment. Following a positive short-term response to bilateral L5/S1 facet joint injections, the L5/S1 facets were treated with radiofrequency ablation of the L4 medial branch and L5 dorsal ramus bilaterally but with minimal benefit. BVNA at L5 and S1 was provided using a bi-pedicular bipolar radiofrequency approach (description attached). Result Six-week outcomes data disclosed decreased pain intensity from 8/10 to 3/10 and improved function with a decrease of 22 points on the oswestry disability index (ODI). Measures of depression, anxiety and stress, and quality of life improved significantly. Opioid usage decreased with a weaning plan. Magnetic resonance imaging (MRI) findings demonstrated new sclerosis with surrounding bone marrow oedema of the right and left sides of the L5 and S1 vertebral bodies consistent with the BVNA treatment. Discussion This case reports technically successful BVNA using a bipedicular approach. The early result is consistent with the published literature using the uni-pedicular approach. Follow-up plans are in place. A case series will follow. In Brief A bi-pedicular bipolar radiofrequency technique for basivertebral nerve ablation to treat vertebrogenic chronic low back pain is described, including early clinical outcomes and MRI findings.

Proton Density Fat Fraction Spine MRI for Differentiation of Erosive Vertebral Endplate Degeneration and Infectious Spondylitis

Vertebral Modic type 1 (MT1) degeneration may mimic infectious disease on conventional spine magnetic resonance imaging (MRI), potentially leading to additional costly and invasive investigations. This study evaluated the diagnostic performance of the proton density fat fraction (PDFF) for distinguishing MT1 degenerative endplate changes from infectious spondylitis. A total of 31 and 22 patients with equivocal diagnosis of MT1 degeneration and infectious spondylitis, respectively, were retrospectively enrolled in this IRB-approved retrospective study and examined with a chemical-shift encoding (CSE)-based water-fat 3D six-echo modified Dixon sequence in addition to routine clinical spine MRI. Diagnostic reference standard was established according to histopathology or clinical and imaging follow-up. Intravertebral PDFF [%] and PDFFratio (i.e., vertebral endplate PDFF/normal vertebrae PDFF) were calculated voxel-wise within the single most prominent edematous bone marrow lesion per patient and examined for differences between MT1 degeneration and infectious spondylitis. Mean PDFF and PDFFratio of infectious spondylitis were significantly lower compared to MT1 degenerative changes (mean PDFF, 4.28 ± 3.12% vs. 35.29 ± 17.15% [p < 0.001]; PDFFratio, 0.09 ± 0.06 vs. 0.67 ± 0.37 [p < 0.001]). The areas under the curve (AUC) and diagnostic accuracies were 0.977 (p < 0.001) and 98.1% (cut-off at 12.9%) for PDFF and 0.971 (p < 0.001) and 98.1% (cut-off at 0.27) for PDFFratio. Our data suggest that quantitative evaluation of vertebral PDFF can provide a high diagnostic accuracy for differentiating erosive MT1 endplate changes from infectious spondylitis.

Deletion of ApoE Leads to Intervertebral Disc Degeneration via Aberrant Activation of Adipokines.

Animal experiment: a mouse model of intervertebral disc (IVD) degeneration induced by deletion of apolipoprotein E (apoE). The aim of this study was to investigate the role and mechanism of apoE on the process of IVD degeneration. Abnormal lipid metabolism has been demonstrated to be closely related to IVD degeneration, a common chronic degenerative joint disease. ApoE, a component of apolipoproteins, plays a crucial role in lipid transportation and metabolic balance. But the relationship between apoE and IVD degeneration remains largely unknown. ApoE knockout (KO) mouse was employed to investigate the progressive disc degeneration. The changes of vertebral bone and intervertebral disc space were measured by micro-computed tomography (micro-CT). The histo-morphological changes of cartilage endplate (CEP) and underlying signals were tested using immunohistochemistry and immunofluorescence staining. The deletion of apoE gene accelerated the lumbar spine degeneration. Compared with WT mice, apoE KO mice showed reduced IVD space and increased vertebral bone mass. The progressive CEP degeneration was further found with cartilage degradation and endplate sclerosis in apoE KO mice. The deletion of apoE stimulated abnormal CEP bone remodeling and activation of adipokines signals. The deletion of apoE gene induced abnormal activation of adipokines signals, thus contribute to the CEP degeneration. N/A.

The value of MRI compared to conventional radiography in analysing morphologic changes in the spine in axial spondyloarthritis

BackgroundImaging of morphologic changes in the vertebral spine in axial spondyloarthritis (SpA) is routinely performed with conventional radiography limited by superposition in the thoracic segments and radiation exposure. The objective was to assess the reliability of MRI compared to conventional radiography in depicting morphologic vertebral lesions in patients with axial SpA. Forty patients diagnosed with axial SpA were included in this cross-sectional study. Patients underwent MRI of the whole spine with T1-weighted and TIRM sequences in the sagittal plane and conventional radiography of the cervical and lumbar spine in lateral projections. Morphologic changes (syndesmophytes and erosions) in the anterior vertebral endplates on MRI and conventional radiography were independently evaluated by two radiologists. Inter-modality and interobserver agreement were calculated using Cohen’s Kappa.ResultsInter-modality agreement was low for cervical and lumbar syndesmophytes and erosions (κ ≤ 0.2 ± 0.07–0.1). Interobserver agreement on conventional radiography was highest for cervical and lumbar anterior syndesmophytes/bridging (κ = 0.92 ± 0.02–0.03). Syndesmophytes in thoracic anterior vertebral units were the most frequent MRI finding with a high interobserver agreement (κ = 0.83 ± 0.05).ConclusionsIn imaging morphologic changes in the spine in patients with axial SpA, MRI was shown to be not an equivalent substitute but a complementary imaging modality to conventional radiography. Conventional radiography seems superior to depict morphologic cervical and lumbar vertebral changes compared to MRI, whereas MRI may visualise morphologic lesions in the thoracic spine.

Better Functional Outcome and Pain Relief in the Far-Lateral-Outside-in Percutaneous Endoscopic Transforaminal Discectomy.

BackgroundEven though percutaneous endoscopic transforaminal discectomy (PETD) has been widely used for the surgical treatment of lumbar herniated disc, there are only a few studies directly comparing the clinical outcomes between microdiscectomy (MD) and PETD. Therefore, further studies are needed in order to compare the clinical outcomes between PETD and MD on a single level more thoroughly.MethodsWe proposed a far-lateral-outside-in technique for PETD to get an entry point without complex planning and facet violation. From September 2017 to September 2019, a total of 155 patients (69 with PETD and 86 with MD) were enrolled for this retrospective study, with the inclusion criteria: single level between L2 and S1, clinical sciatica for at least 6 weeks, and failed attempts with non-surgical treatments. Patients were excluded due to cauda equina syndrome, progressive neurologic deficits, history of lumbar spinal surgery, endplate modic changes, severe disc degeneration and less than 24 months of follow-up.ResultsPETD showed significantly shorter surgery time and less intraoperative blood loss compared to MD. The difference between PETD and MD in VAS back pain (but not VAS leg pain) at follow-up time was significant. The ODI improvement in the follow-up time of 6 months between the 2 groups showed a significant difference (PETD: 31.23±6.59, MD: 39.85±7.81, p < 0.001). MD had a significantly higher chance of postoperative wound infection and poor healing, while PETD was more likely to have recurrence of the herniated disc.ConclusionMD has been the gold standard procedure for LDH. However, with the advanced endoscopic technology and surgical technique, PETD has emerged as an alternative method due to higher functional outcome and less wound problems.

Detailed Subphenotyping of Lumbar Modic Changes and Their Association with Low Back Pain in a Large Population-Based Study: The Wakayama Spine Study.

IntroductionTo examine the association between the five types of Modic changes and low back pain (LBP) in a large population-based cohort.MethodsOf the 952 participants in the second Wakayama Spine Study, 814 (men, 246; women, 568; mean age, 63.6 years) were included in this study. Endplate changes on magnetic resonance imaging were classified according to the Modic classification system. Low back pain (LBP) was defined as continuous back pain for at least 48 h in the past month that is currently present. The prevalence of Modic changes in the lumbar region was assessed. Multivariate logistic regression analysis was conducted to determine the association between detailed subphenotype of Modic change and LBP comparing no Modic change in the lumbar spine and each level, respectively.ResultsModic changes throughout the lumbar spine were noted in 63.5% (n = 516) of all participants, with types I, I/II, II, II/III, and III observed in 7.8% (n = 63), 10.8% (n = 88), 40.0% (n = 326), 2.1% (n = 17), and 2.7% (n = 22), respectively. Modic types I/II were associated with LBP [odds ratio (OR): 3.26; 95% confidence interval (CI) 1.9, 5.5]. Furthermore, Modic type I/II changes at L2/3 and L4/5 were significantly associated with LBP (odds ratio: 2.77; 95% CI 1.04, 7.39 at L2/3; odds ratio: 2.86; 95% CI 1.39, 5.90 at L4/5).ConclusionsType I/II Modic changes in the lumbar region are significantly associated with LBP. To the best of our knowledge, this is the first large population-based study on the association between various Modic changes and LBP.

Obesity could be associated with poor paraspinal muscle quality at upper lumbar levels and degenerated spine at lower lumbar levels: Is this a domino effect?

Vertebral end-plate changes and paraspinal muscles are recently getting much more attention, since they could be associated with intervertebral disc degeneration (IVDD) and low back pain (LBP). Even though obesity is known as a risk factor for LBP, the role of obesity in the process of LBP is still controversial. In this study, we aimed to identify whether increased body mass index (BMI) was associated with IVDD, vertebral end-plate changes and paraspinal muscle quality. Consecutive women and men, aged between 20 and 50 years, presented with chronic LBP to the outpatient clinics were included. Patients were evaluated in terms of IVDD, vertebral end-plate changes, fatty infiltration in the paraspinal muscles at all lumbar levels on magnetic resonance imaging. Severe IVDD was more common in obese patients than in non-obese patients (73.5% vs. 50.4%, p = 0.017). When we compared the groups level by level, the significant difference for severe IVDD was present only at L4-L5 disc level (50% vs. 27.4%, p = 0.013). There was a higher trend of harboring Modic change at any lumbar level in obese patients, significantly in women (35.9% vs. 16.4%, p = 0.026). More severe fatty infiltration in the paraspinal muscles was seen at upper lumbar levels of the obese patients, particularly in women. Patients with higher BMI and suffering from LBP, had more fatty infiltration in the paraspinal muscles at the upper lumbar levels, more severe IVDD, and Modic changes at the lower lumbar levels; particularly women.

The influence of spinal position on imaging findings: an observational study of thoracolumbar spine upright MRI in elite gymnasts

PurposeTo investigate whether upright magnetic resonance imaging (MRI) has a role in defining thoracolumbar spine pathology in elite gymnastics.MethodsA prospective cross-sectional observational study of National Senior and Junior Artistic gymnasts in three MRI positions (standard supine, upright flexed and extended positions). Two specialist musculoskeletal radiologists independently analysed images with neutral as a baseline with the effects of flexion and extension reported in line with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.ResultsForty (18 males) gymnasts aged 13–24 years with a mean (SD) of 32 (5.3) training hours per week consented with 75% showing MRI abnormalities. Degenerative disc disease (DDD) was evident in 55% participants with vertebral end plate (VEP) changes in 42.5%. Spondylolysis was present in 40% with an additional 17% showing chronic bilateral complete L5 pars defects. 23% participants demonstrated different MRI findings in upright flexion compared to neutral.ConclusionFindings suggest a high levels of MRI abnormalities in elite gymnastics including altered disc morphology and posterior element abnormalities. High prevalence of T11/12 DDD and VEP changes reflects the thoracolumbar junction being a transition zone. Upright MRI and varying spine position offer promise for enhanced visualisation of posterior element abnormalities.

Endplate defects, not the severity of spinal stenosis, contribute to low back pain in patients with lumbar spinal stenosis

BACKGROUND CONTEXTIt is controversial whether lumbar spinal stenosis (LSS) itself contributes to low back pain (LBP). Lower truncal skeletal muscle mass, spinopelvic malalignment, intervertebral disc degeneration, and endplate abnormalities are thought to be related to LBP. However, whether these factors cause LBP in patients with LSS is unclear. PURPOSETo identify factors associated with LBP in patients with LSS. STUDY DESIGN/SETTINGCross-sectional design. PATIENT SAMPLEA total of 260 patients (119 men and 141 women, average age 72.8 years) with neurogenic claudication caused by LSS, as confirmed by magnetic resonance imaging (MRI). OUTCOME MEASURESRatings of LBP, buttock and leg pain, and numbness on a numerical rating scale (NRS), 36-Item Short Form Survey (SF-36) scores, muscle mass measured by bioelectrical impedance analysis, and radiographic measurements including slippage and lumbopelvic alignment. The severity of LSS, endplate defects, Modic endplate changes, intervertebral disc degeneration, and facet joint osteoarthritis were assessed on MRI. METHODSThe presence of LBP was defined as an NRS score ≥3. The demographic data, patient-reported outcomes, and radiological and MRI findings were compared between patients with and without LBP. Multivariate logistic regression analysis was used to identify the factors that were independently associated with the presence of LBP. RESULTSThere were significant differences between patients with and without LBP for buttock and leg pain and numbness on the NRS, general health on the SF-36, presence of endplate defects, presence of Modic changes, disc degeneration grading, and disc height grading (all p < .05). Multivariate logistic regression analysis showed significant associations between LBP and diabetes (OR 2.43; 95% CI 1.07–5.53), buttock and leg numbness on the NRS (OR 1.34; 95% CI 1.17–1.52), general health on the SF-36 (OR 0.97; 95% CI 0.95–0.99), and the presence of erosive endplate defects (OR 3.04; 95% CI 1.51–6.11) (all p < .05). CONCLUSIONSThese results suggest that LBP in patients with LSS should be carefully assessed not only for spinal stenosis but also clinical factors and endplate defects.

Vertebral Endplate Changes Correlate with Presence of Cartilaginous Endplate in the Herniated Disc Tissue: Factor Predicting Failure of Conservative Treatment.

Study DesignCross-sectional comparative.PurposeTo characterize the scores of disc degeneration, inflammation, and nerve density in herniated disc samples and associate findings with the presence of vertebral endplate (VEP) changes on magnetic resonance imaging (MRI).Overview of LiteratureConsidering the role of disc composition in spontaneous regression and persistence of pain during conservative management, it is important to identify the influencing factors. VEP changes are highly associated with disc degeneration, but their correlation with herniated disc composition has not yet been reported.MethodsFifty-one discs were obtained from patients undergoing surgery for herniated disc. Their ages ranged from 19–65 years, and 31/51 were male. Pre-surgical T1 and T2 weighted lumbar-spine MRIs were analyzed to observe Pfirrmann grade, VEP defects, herniation type, Modic changes, and high-intensity zones (HIZ) at the affected level. Five-micron thick sections were stained with hematoxylin and eosin, Alcian blue periodic acid–Schiff stain; examined for histological degeneration scores (HDS; 0–15), inflammation (0 [absence]–3 [severe]), and presence of cartilaginous endplate (CEP). Three-micron thick sections were stained with protein-gene-product 9.5 and expression was counted/mm2. Data was analyzed, and p<0.05 was considered to indicate statistical significance.ResultsVEP defects, Modic changes, and HIZ were respectively observed in 30/51, 16/51, and 6/51 of the samples. CEP was observed in 26/51 samples and in 23/51 with endplate defects. Discs with adjacent VEP defects showed increased HDS (p<0.001) and inflammation (p<0.001). Discs with adjacent Modic changes also revealed increased HDS (p=0.01). Histological sections with CEP showed increased HDS (p<0.001) and inflammation (p<0.001), and nerve density was significantly positively correlated with HDS (r=0.27, p=0.02).ConclusionsVEP changes can modulate degeneration and inflammation of herniated discs. Presence of these changes is highly predictive of the occurrence of CEP in herniated discs, which leads to slow resorption and persistent clinical symptoms.

CORRELATION OF MAGNETIC RESONANCE IMAGING CHANGES OF MULTIFIDUS MUSCLE WITH OTHER DEGENERATIVE CHANGES AT LUMBOSACRAL SPINE IN PATIENTS WITH LOW BACK PAIN

Background: Multifidus muscle (MF) in the back of the vertebral column plays an important role in spinal stability. MF morphology and fatty infiltration can be influenced by factors affecting low back pain (LBP) and evaluated using MRI, CT and US, however MRI provides a higher resolution and allows for better detection of soft tissues.Objective: We proposed a new method to assess the degree of MF degeneration. Methods: The multifidus score was calculated by summation of degree of MF degeneration, with minimum score of 0 and maximum of 6. In cases of disproportion affection of MF on each side, we chose the higher degree of MF affection. Score of 6 means that MF degeneration is graded 2 in either side. We mentioned the influence of other vertebral degenerative pathologies including facet arthropathies, neural canal stenosis and Modic end plate changes. We defined disc pathology as disc bulge, herniation. The main factors affecting MF degeneration are age, body mass index (BMI), duration of compliant in years, presence of sciatica and VAS visual analogue scale (VAS) score.Results: VAS scores were statistically significantly correlated with degree of MF degeneration, with p value < 0.001. The degree of MF degeneration was significantly correlated with number of disc pathologies. Conclusion: Our study concluded a significant relation between MF degeneration and each of VAS and duration of pain, although this relation was not related to the measurement of proportionate changes between each side and different degrees of MF degeneration.

Clinical and radiographic outcomes of hybrid graft in patients with Modic changes undergoing transforaminal lumbar interbody fusion

BackgroundThis retrospective study aimed to analyze the influence of Modic changes (MCs) on the clinical and radiographic outcomes of transforaminal lumbar interbody fusion with hybrid graft.MethodsClinical data of 89 patients with Modic changes who underwent single-segment transforaminal lumbar interbody fusion between January 2015 and January 2019 at our institution were analyzed. Patients were divided into three groups: the MCs-0 group (no endplate changes; used as the control group), the MCs-1 group, and the MCs-2 group. Clinical and radiological parameters were compared between the three groups.ResultsThere were no significant between-group differences in age (P = 0.216), sex (P = 0.903), body mass index (P = 0.805), smoking (P = 0.722), diagnosis (P = 0.758), surgical level (P = 0.760), blood loss (P = 0.172), operative time (P = 0.236), or follow-up (P = 0.372). Serum C-reactive protein level and erythrocyte sedimentation rate in the MCs-1 and MCs-2 groups were significantly higher than those in the MCs-0 group on the third and seventh days (P < 0.05). Postoperative radiographic parameters were significantly higher than preoperative parameters in all 3 groups (P < 0.05). Visual analog scale scores for low back pain in the MCs-0 and MCs-2 groups were significantly different from those in the MCs-1 group (P < 0.05). However, there were no significant between-group differences with respect to Oswestry Disability Index scores or visual analog scale scores for leg pain.ConclusionIn this study, Modic changes had no impact on fusion rates and clinical outcomes of transforaminal lumbar interbody fusion with hybrid graft (autologous local bone graft plus allogeneic freeze-dried bone graft). However, MCs-1 increased the risk of cage subsidence and showed superior outcomes in terms of visual analog scale scores for low back pain.

Morphological Changes in the Motor Endplate and in the Belly Muscle Induced by Previous Static Stretching to the Climbing Protocol.

Static stretching provides benefits to the range of motion, modulates intramuscular connective tissue, and is incorporated into warm-up exercises. In this study, we present the effects in the motor endplate and belly muscle resulting from previous static stretching to climbing training. Twenty-four adult male Wistar rats were divided into four groups (n = 6 each): Sedentary (Sed), Climbing (Clb), Static stretching (Ss), and Static stretching prior to climbing (Ssc). The animals (Clb, Ss, and Ssc groups) were subjected to a training protocol 3×/week for 8 weeks, and the Ssc group was subjected to the Ss and Clb protocols in the same session. Samples from the animals were processed for immunostaining, histochemistry, and light microscopy. The Clb group presented a higher motor endplate; the Ss group presented no changes in the motor endplate; and the Ssc group demonstrated a higher compactness. We concluded that static stretching prior to the climbing protocol maintained the density of the motor endplate and increased the compactness of the neuromuscular junction structure. Also, there was a reduction in the myofibers’ diameter (Type I and IIa), an increase in myofibrillar densities (Type I and IIx, and total), and the reorganization of the myonuclei and the interstitium.

Treatment of Degenerative Disc Disease associated with Modic changes, with ozone therapy. A new therapeutic proposal.

Introduction.&#x0D; Modic Changes (MCs) represent signal changes in the vertebral endplate and subchondral bone region visualized on T1 and T2 weighted magnetic resonance images (MRI). Three types of MCs It have been identified (Types 1 to 3). Modic changes are commonly associated with low-back pain (LBP). &#x0D; In the last few years scientific papers have shown that one of the causes of MCs (fundamentally, the MCs type 1) is the infection caused by an anaerobic bacterium of very low virulence: Propionibacterium acnes (P. acnes). This bacterium resides on the human skin, oral cavity, intestinal tract, and external ear canal as normal flora. As a consequence of tooth brushing and endodontic-therapy, could invade the blood stream leading to transient bacteremia. The authors propose a treatment which consists of Amoxicillin-clavulanate (500 mg/125 mg) three times a day, at 8-hour intervals, for 90 days/100 days.&#x0D; Objectives.&#x0D; Ozone therapy could be the gold standard therapy for MC1 because ozone is a powerful anti-microbial, anti-inflammatory and analgesic agent, which regulates oxidative stress, immune system and oxygen metabolism. &#x0D; Materials and Methods &#x0D; Patients with LBP lasting 6 months or more and MC1 confirmed by MRI of lumbar spine L3/L4 or L4/L5 or L5/S1 and who responded with 5 or more points on the VAS scale were treated with three intradiscal sessions of ozone therapy and ten paravertebral sessions. &#x0D; Results.&#x0D; Patients who were treated with ozone therapy according to our treatment proposal showed a substantial improvement on VAS comparing the beginning and the end of the treatment. They show a significant difference in pain, and general condition. However, these results were not reflected on ODI scale, neither on the MRI but we could notice certain improvements.

Modic changes in the lumbar spine: histology, risk factors, clinical presentation and treatment

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.