Modic Changes In Patients Research Articles

Modic changes in patients with lumbar disc herniation followed more than 1 year after lumbar discectomy: a systematic review and meta-analysis.

Modic changes (MCs) are identified as an independent risk factor for low back pain. Different subtypes of MCs vary in their impact on postoperative pain relief. However, consensus on the transformation of postoperative MC fractions in patients with distinct MC subtypes is lacking. This comprehensive systematic review and meta-analysis searched English-language articles in PubMed, Cochrane Library, Web of Science, and Embase databases until January 2024. Studies included focused on patients transitioning between various microcrack subtypes post-discectomy. The primary outcome measure was the transformation between different postoperative microcrack fractions. Eight studies with 689 participants were analyzed. Overall, there is moderate to high-quality evidence indicating differences in the incidence of MC conversion across MC subtypes. The overall incidence of MC conversion was 27.7%, with rates of 37.0%, 20.5%, and 19.1% for MC0, MC1, and MC2 subtypes, respectively. Thus, postoperative MC type transformation, particularly from preoperative MC0 to MC1 (17.7%) or MC2 (13.1%), was more common, with MC1 transformation being predominant. Patients with preoperative comorbid MC1 types (19.0%) exhibited more postoperative transitions than those with MC2 types (12.4%). This study underscores the significance of analyzing post-discectomy MCs in patients with lumbar disc herniation, revealing a higher incidence of MCs post-lumbar discectomy, particularly from preoperative absence of MC to MC1 or MC2. Preoperative MC0 types were more likely to undergo postoperative MC transformation than combined MC1 or MC2 types. These findings are crucial for enhancing surgical outcomes and postoperative care.

Study of the Distribution of Lumbar Modic Changes in Patients with Low Back Pain and Correlation with Lumbar Degeneration Diseases [Response to Letter

Study of the Distribution of Lumbar Modic Changes in Patients with Low Back Pain and Correlation with Lumbar Degeneration Diseases [Response to Letter

Re: Study of the Distribution of Lumbar Modic Changes in Patients with Low Back Pain and Correlation with Lumbar Degeneration Diseases [Letter

Re: Study of the Distribution of Lumbar Modic Changes in Patients with Low Back Pain and Correlation with Lumbar Degeneration Diseases [Letter

Study of the Distribution of Lumbar Modic Changes in Patients with Low Back Pain and Correlation with Lumbar Degeneration Diseases.

To study the distribution of lumbar Modic changes (MC) in low back pain patients, and to explore the relationship between Modic changes and age, gender, segment and lumbar degeneration diseases (disc degeneration, spinal stenosis, lumbar spondylolisthesis). Modic changes were counted and analysed in 500 randomly selected patients who visited the outpatient clinic for lumbar spine MRI for low back pain from 2019 to 2022. The relationship between Modic changes and bulging disc, protrusion, extrusion, sequestration, Schmorl's node, spinal stenosis, and lumbar spondylolisthesis was studied. Data correlations were compared using the chi-square test, P<0.05 was considered a statistically significant difference. Modic changes were present in 184 segments. 58 were type I, 119 were type II, and 7 were type III. The number of Modic changes segments in L1-2, L2-3, L3-4, L4-5, and L5-S1 was 10, 22, 22, 58, and 72, respectively. Modic changes by gender occurred in 44 males and 82 females, and by age grouping were 0 cases in 10-19 years, 3 cases in 20-29 years, 6 cases in 30-39 years, 41 cases in 40-49 years, 64 cases in 50-59 years, 38 cases in 60-69 years, 15 cases in 70-79 years, and 5 cases in 80-89 years, respectively. Modic changes occurred in 56 with bulging disc, 45 with Protrusion, 57 with Extrusion and Sequestration, 32 with Schmorl's node, 32 with spondylolisthesis, and 56 with stenosis. Modic changes correlated with all of the above factors except bulging disc, and all differences were statistically significant (P<0.05). The most common type of Modic changes is type II; Modic changes have correlation with age, gender, segment, lumbar disc herniation, lumbar spondylolisthesis, and lumbar spinal stenosis, and are a very important factor in low back pain.

Association of Modic Changes with Low Chronic Low Back Pain

Objective: To determine the association of Modic changes with chronic low back pain in the adult population &#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Department of Neurosurgery, Combined Military Hospital, Lahore Pakistan, from Jan to Mar 2022.&#x0D; Methodology: All the patients who were diagnosed with chronic low back pain by Neurosurgeon were included in the study.Detailed history and physical examination were conducted on all the patients diagnosed with chronic low back pain. MRI spine was performed on all the study participants for Modic changes. Relevant socio-demographic factors were associated with different types of Modic changes in patients included in our analysis.&#x0D; Results: Out of 300 patients managed for chronic low back pain during the study period, 201(67%) were male, while 99(33%) were female. 172(57.3%) had no Modic changes, 33(11%) had Type-I changes, 80(26.7%) had Type-II changes, and 15(5%) had Type-III Modic changes. Advancing age, female gender and presence of comorbid illness had a statistically significant relationship with Modic changes in study participants (p-value&lt;0.05).&#x0D; Conclusion: Modic changes were commonly seen in patients with low back pain. Type II Modic changes were most frequently seen in these patients. Elderly and female patients were more at risk of Modic changes than young and male patients. Comorbid medical illnesses also increase the chances of having Modic changes.

Asymmetric distribution of Modic changes in patients with lumbar disc herniation.

This study aims to report a new distribution pattern of Modic changes (MCs) in patients with lumbar disc herniation (LDH) and investigate the prevalence, correlative factors and clinical outcomes of asymmetric Modic changes (AMCs). The study population consisted of 289 Chinese Han patients who were diagnosed with LDH and single-segment MCs from January 2017 to December 2019. Demographic, clinical and imagological information was collected. Lumbar MRI was performed to assess MCs and intervertebral discs. The visual analogue score (VAS) and Oswestry disability index (ODI) were evaluated in patients undergoing surgery preoperatively and at the final follow-up. Correlative factors contributing to AMCs were analysed by multivariate logistic regression. The study population included 197 patients with AMCs and 92 patients with symmetric Modic changes (SMCs). The incidence of leg pain (P < 0.001) and surgical treatment (P = 0.027) in the AMC group was higher than that in the SMC group. The VAS of low back pain was lower (P = 0.048), and the VAS of leg pain was higher (P = 0.036) in the AMC group than in the SMC group preoperatively. Multivariate logistic regression analysis revealed that leg pain (OR = 2.169, 95% CI = 1.218 ~ 3.864) and asymmetric LDH (OR = 7.342, 95% CI = 4.170 ~ 12.926) were independently associated with AMCs. The receiver operating characteristic curve showed an AUC of 0.765 (P < 0.001). AMCs were a more common phenomenon than SMCs in this study. The asymmetric and symmetric distribution of MCs was closely related to LDH position. AMCs were related to leg pain and higher pain levels. Surgery can achieve satisfactory clinical improvement for asymmetric and symmetric MCs.

The Influence of Roussouly Type on the Prevalence, Subtype, and Distribution Characteristics of Modic Changes in Patients with Lumbar Degenerative Disc Disease

The relationship between Roussouly type and Modic changes (MC) is unknown. The aim of our study was to investigate the influence of Roussouly type on the characteristics of MC in patients with lumbar degenerative disc disease. This cross-sectional observational study from Huashan Hospital included 270 patients with lumbar degenerative disc disease. Subjects were divided into 4 groups according to the Roussouly classification. Prevalence, subtype, and distribution characteristics of MC from L1-L2 upper end plate to L5-S1 lower end plate were compared between 4 Roussouly types. Of 270 patients, 65 (24.1%) were Roussouly type I, 115 (42.6%) were Roussouly type II, 55 (20.4%) were Roussouly type III, and 35 (13.0%) were Roussouly type IV. MC were present in 45.9% (n= 270) of patients, 12.7% (n= 2700) of end plates, and 11.8% (n= 1350) of intervertebral discs. The prevalence rate of MC by subtype and intervertebral disc among the 4 Roussouly types was statistically different (P < 0.05), and the prevalence rate of MC by intervertebral disc in Roussouly type I was statistically higher than the other 3 Roussouly types. In Roussouly types I and IV, the prevalence rate of MC at L4-L5 level showed no significant differences compared with those at upper lumbar levels, while in Roussouly types II and III, the prevalence rate of MC at L4-L5 level was significantly higher than those at upper lumbar levels. Roussouly types can influence prevalence, subtype, and distribution characteristics of MC in patients with lumbar degenerative disc disease.

Serum biomarkers for Modic changes in patients with chronic low back pain.

Lumbar Modic change (MC) can serve as a diagnostic marker as well as an independent source of chronic low back pain (CLBP). This study aimed to test for the existence of serum biomarkers in CLBP patients with MC. Age- and sex-matched CLBP patients with confirmed MC on lumbar MRI (n = 40) and pain-free controls (n = 40) were assessed. MC was classified into M1, predominating M1, predominating M2 and M2. MC volumes were calculated. Fasting blood samples were assessed for inflammatory mediators, signalling molecules, growth factors and bone turnover markers. Serum concentrations of 46 biomarkers were measured. Median concentrations of interleukin (IL)-15 (p < 0.001), IL-8 (p < 0.001), tumour necrosis factor (TNF)-alpha (p < 0.001), Eotaxin-1 (p < 0.05), Eotaxin-3 (p < 0.001), monocyte chemotactic protein (MCP)-1 (p < 0.05), macrophage inflammatory protein (MIP)-1alpha (p < 0.01), TEK receptor tyrosine kinase (Tie)-2 (p < 0.001), vascular cell adhesion molecule (VCAM)-1 (p < 0.001), RANTES (p < 0.001), C telopeptide of type I collagen (CTX)-1 (p < 0.001), vascular endothelial growth factor (VEGF)-C (p < 0.001), VEGF-D (p < 0.05), fms-related tyrosine kinase (Flt)-1 (p < 0.01) and intercellular adhesion molecule (ICAM)-1 (p < 0.01) were significantly higher among controls. IL-1sRII (23.2 vs. 15.5ng/ml, p < 0.001) and hepatocyte growth factor (HGF)-1 (169 vs. 105pg/ml, p < 0.01) concentrations were significantly higher among patients. Type or volume of MC was not associated with biomarker concentrations. This is the first study to assess the blood serum biomarker profile in individuals with CLBP with MC. Several biomarkers were suppressed, while two markers (IL-1sRII and HGF) were elevated among MC patients, irrespective of MC type or size, with CLBP compared with asymptomatic controls.

Molecular detection of Propionibacterium acnes in biopsy samples of intervertebral disc with modic changes in patients undergoing herniated disc surgery.

Background and Objectives:Recent studies have hypothesized that sterile disc infection with the anaerobic Propionibacterium acnes, recently renamed Cutibacterium acnes, occurs in people with intervertebral disc (IVD) herniation. This study aimed to examine the presence of P. acnes in patients who have Low back pain (LBP) with Modic changes observed in their Magnetic Resonance Imaging (MRI).Materials and Methods:Thirty-seven patients who were candidates for surgery due to disc herniation and demonstrated Modic changes in MRI were included in the study. Before the surgery, the level of pain in patients was assessed using the visual analog score (VAS). All patients were asked to fill in the Oswestry Low Back Pain Disability Questionnaire. Intervertebral disc changes observed in MRI were recorded for all patients. Then, during surgery, sterile intervertebral disc samples were taken. P. acnes detection was performed using PCR in the laboratory. Data analysis with Chi-squared test, independent samples t-test, and Mann-Whitney U test in SPSS 18.0.Results:The mean age of 37 patients equaled 43.64 years and the mean duration of symptoms was 11.05 months. In molecular examination, of the 37 individuals, the genome of P. acnes was positive in 23 cases (62.2%) and negative in 14 (37.8%). The relationship between VAS, disability score, changes in MRI, and patients’ age with the positivity of the intervertebral disc sample was also assessed. Of these variables, only age was significantly correlated with the positive molecular finding, such that with an increase in age, the probability of positive findings was increased (p = 0.022).Conclusion:Based on the results, lumbar disc infection with P. acnes may play a significant role in causing Modic changes and the progression of the disease in patients with LBP.

Relation Between Neck Pain and Modic Changes in Cervical Spondylotic Myelopathy.

BackgroundModic changes on magnetic resonance imaging (MRI) represent lesions in the bone marrow of the vertebral body that may be associated with pain. This study investigated the relationship between neck pain and cervical Modic changes, and risk factors for neck pain (NP).Material/MethodsThis study included 168 patients diagnosed with cervical spondylotic myelopathy between February 2013 and April 2017. Basic patient information about demographic and lifestyle variables was obtained from medical records. Radiographic images provided cervical alignment (C2–C7 Cobb), T1 slope and C7 slope. All patients underwent MRI to evaluate the presence of Modic changes. Univariate analyses identified the variables as potential factors. Variables with a p<0.10 were included in the multivariate logistic regression analysis models. P-values <0.05 were statistically significant.ResultsOnly 93 patients (55.4%) had NP. Modic changes in patients with NP were significantly higher than those without Modic changes (p=0.002). Eighty-five patients had Modic changes types I, II, III; 41 (48.2%), 29 (34.1%), 15 (17.6%), respectively. The distribution of these Modic changes varied with NP (p<0.001). Type I Modic changes were seen with NP more frequently than other types of Modic changes. Univariate and multivariate analyses showed that age (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.02–1.16) and Modic changes (OR 1.25; 95% CI, 0.09–1.46) were significant independent factors for NP.ConclusionsIn cervical spondylosis, age and Modic changes were associated with NP. Modic change type I is more likely to occur with NP.

Analysis of Correlation Between Age and Cervical Facet Joint Degeneration and Modic Changes in Patients with Cervical Spondylotic Myelopathy.

BackgroundBecause facet joints move with the disc, changes in vertebral bodies occur simultaneously with progression of degeneration of cervical facet joints. This study investigated age-related differences in cervical facet joint abnormalities and multi-dimensional characteristics of MCs in patients with cervical spondylotic myelopathy.Material/MethodsForty-five patients underwent both magnetic resonance imaging (MRI) and computed tomography (CT) of the cervical spine. Axial and sagittal parameter changes from C3 to C7, including facet orientation (FO) and facet tropism (FT), and Modic changes (MCs), were evaluated and documented preoperatively, and we also measured the heights and diameters of MCs and performed correlation analysis and established linear regression models.ResultsThe axial facet orientation increased slightly from C3 66.5 (11.4) to C7 89.9 (19). The sagittal facet orientation and facet tropism increased between C3–C4 and C6–C7, but it decreased between C4 to C6. The MCs volume decreased from C3 to C4 and increased from C4 to C7. There was a gradual decrease of FO and FT from C3 to C5 and a gradual increase of these 2 angles from C5 to C7 in all age groups. The lowest values of FO and FT were detected at C5, while the highest values of FO and FT were detected at C7.ConclusionsAge was negatively correlated with the axial, sagittal, and coronal cervical facet orientation, especially at C4/5 level. The FT with respect to the axial and sagittal plane from C5 to C6 increased with age.

Distribution of Modic changes in patients with low back pain and its related factors

BackgroundTo summarize the clinical distribution of Modic changes in patients with low back pain and explore the related factors.MethodsA total of 153 patients were enrolled. Gender, age, disk degeneration, herniation, involved segments, lumbar lordosis angle, and endplate concave angle were recorded, respectively. Patients were divided into two or more groups according to a different classification. The relevant factors were studied with a multivariate logistic regression analysis to analyze their correlation.ResultsA total of 35 patients with type I changes, 110 patients with type II changes, and 8 patients with type III changes. In total, 204 disks were found with Modic changes, L1/2 (10 disks), L2/3 (18 disks), L3/4 (17 disks), L4/5 (76 disks), and L5/S1 (81 disks). Type I changes were distributed mainly under the age of 50. Multivariate regression showed that gender, age, disk degeneration, lumbar lordosis, L4/5 segment lordosis angle, and L5 lower endplate concave angle were related with different types of Modic changes. The regression equation Y = 2.410 − 1.361S − 0.633A − 0.654P + 1.106L − 0.990D (Y means type I changes, S means gender, A means age, P means disk degeneration, L means L4/5 segment lordosis angle, and D means L5 upper endplate concave angle). The OR values were S = 0.256, A = 0.531, P = 0.520, L = 3.022, D = 0.372, respectively.ConclusionsType II changes are the most common, followed by type I. Modic changes mostly occur in L4/5 and L5/S1; young, male, lower-grade disk degeneration, normal physiological curvature of the lumbar spine, and normal endplate concave angle were associated with type I changes; gender and lumbar curvature were the most relevant factors for different types.

C7 slope and its association with serum lipid levels and Modic changes in patients with cervical spondylotic myelopathy.

Background: Several studies have substituted the T1 slope (T1S) with the C7 slope (C7S) because the C7 endplate is clearer on radiographs. Further, abnormal serum lipid levels have been proven to be related with the development of disc degeneration. The aim of this study was to explore the relationship between C7S, serum lipid levels, cervical parameters related to cervical sagittal balance and Modic changes (MCs) in patients with multisegment cervical spondylotic myelopathy (CSM).Methods: Between January 2014 and January 2017, 75 patients with multisegment CSM were enrolled in our retrospective study. Gender, age, history of smoking status and alcohol consumption, and laboratory test data were recorded. The cervical sagittal balance parameters C7S, T1S, cervical lordosis (CL), neck tilt (NT), thoracic inlet angle (TIA), C2–C7 sagittal vertical axis (SVA), and T1S-CL were analyzed with Spearman correlation tests and multiple linear regression analysis. We diagnosed MCs through computed tomography or magnetic resonance imaging of the cervical spine. Patients were divided into four subgroups according to the presence or absence of MCs and their C7S values.Results: 75 patients were included in our study. Age, gender, C7S, and T1S were significantly different between the two groups. However, there was no statistical difference with regard to smoking status, alcohol consumption, lipoprotein(a), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, albumin, globulin, triglycerides, total cholesterol, Ca2+, CL, T1S, TIA, NT, and T1S−CL. The correlation between HDL-C, LDL-C, ALB, GLB, Ca2+, C7S, T1S, MCs, NT, TIA, and C2–C7 SVA was statistically significant.Conclusion: Significant correlations were observed between MCs and TG (as well as other preoperative sagittal parameters), which may accelerate the development of degeneration of the cervical spine. Therefore, alcohol consumption, TG, and sagittal parameters, such as C7S, and T1S could be a promising candidate for the assessment of cervical sagittal balance and predicting neck pain.

Exploratory study for clinical signs of MODIC changes in patients with low-back pain in the Netherlands armed forces

BackgroundMagnetic resonance imaging (MRI) is being used extensively in the search for pathoanatomical factors contributing to low back pain (LBP) such as Modic changes (MC). However, it remains unclear whether clinical findings can identify patients with MC. The purpose of this explorative study was to assess the predictive value of six clinical tests and three questionnaires commonly used with patients with low-back pain (LBP) on the presence of Modic changes (MC).MethodsA retrospective cohort study was performed using data from Dutch military personnel in the period between April 2013 and July 2016. Questionnaires included the Roland Morris Disability Questionnaire, Numeric Pain Rating Scale, and Pain Self-Efficacy Questionnaire. The clinical examination included (i) range of motion, (ii) presence of pain during flexion and extension, (iii) Prone Instability Test, and (iv) straight leg raise. Backward stepwise regression was used to estimate predictive value for the presence of MC and the type of MC. The exploration of clinical tests was performed by univariable logistic regression models.ResultsTwo hundred eighty-six patients were allocated for the study, and 112 cases with medical records and MRI scans were available; 60 cases with MC and 52 without MC. Age was significantly higher in the MC group. The univariate regression analysis showed a significantly increased odds ratio for pain during flexion movement (2.57 [95% confidence interval (CI): 1.08–6.08]) in the group with MC. Multivariable logistic regression of all clinical symptoms and signs showed no significant association for any of the variables. The diagnostic value of the clinical tests expressed by sensitivity, specificity, positive predictive, and negative predictive values showed, for all the combinations, a low area under the curve (AUC) score, ranging from 0.41 to 0.53. Single-test sensitivity was the highest for pain in flexion: 60% (95% CI: 48.3–70.4).ConclusionNo model to predict the presence of MC, based on clinical tests, could be demonstrated. It is therefore not likely that LBP patients with MC are very different from other LBP patients and that they form a specific subgroup. However, the study only explored a limited number of clinical findings and it is possible that larger samples allowing for more variables would conclude differently.

Are Modic changes in patients with chronic low back pain indicative of a worse clinical course? 10 years of follow-up

ObjectiveEstablish the long-term (10 years) predictive value of Modic changes in the course of lumbar pain and the need for surgical treatment. Material and methodObservational longitudinal prospective cohort study. Comparison of progression at 10 years of 2 groups of patients with chronic lumbar pain: group A with Modic changes in MRI and group B with no Modic changes. Exclusion criteria: neoplasia, inflammatory or infectious diseases, or previous surgery. Assessment was done with the aid of the VAS for low lumbar and radicular pain and the Oswestry Disability Questionnaire. The need for surgical or medical treatment and occupational disability during the study period was analysed. For the statistical analyses, the Mann–Whitney U test and logistic regression were applied. ResultsSeventy patients, 24 male and 46 female, with a mean age of 56.5 years (35 in each group) were included in the study. No statistically significant differences in the intensity of lumbar pain, degree of impairment, or need for medical or surgical treatment (p>.05) were found in patients with Modic changes types 1, 2, or 3 between the baseline assessment and 10 years after. No statistically significant differences between patients with/without changes in Modic at 10 years of follow-up (p>.05) were determined. ConclusionsThere is no relationship between Modic changes in MRI and greater intensity of lumbar pain or need for medical or surgical treatment at 10 years of follow-up. Modic changes cannot be considered a sign of bad prognosis by themselves, or an indication for surgery.

Single Nucleotide Variants of Candidate Genes in Aggrecan Metabolic Pathway Are Associated with Lumbar Disc Degeneration and Modic Changes.

IntroductionLumbar disc degeneration (LDD) is genetically determined and severity of LDD is associated with Modic changes. Aggrecan is a major proteoglycan in the intervertebral disc and end plate. Progressive reduction of aggrecan is a main feature of LDD and Modic changes.ObjectivesThe study investigated the associations of single nucleotide variants (SNVs) of candidate genes in the aggrecan metabolic pathway with the severity of LDD and Modic changes. In-silico functional analysis of significant SNVs was also assessed.MethodsA descriptive cross sectional study was carried out on 106 patients with chronic mechanical low back pain. T1, T2 sagittal lumbar MRI scans were used to assess the severity of LDD and Modic changes. 62 SNVs in ten candidate genes (ACAN, IL1A, IL1B, IL6, MMP3, ADAMTS4, ADAMTS5, TIMP1, TIMP2 and TIMP3) were genotyped on Sequenom MassARRAY iPLEX platform. Multiple linear regression analysis was carried out using PLINK 1.9 in accordance with additive genetic model. In-silico functional analysis was carried out using Provean, SIFT, PolyPhen and Mutation Taster.ResultsMean age was 52.42±9.42 years. 74 (69.8%) were females. The rs2856836, rs1304037, rs17561 and rs1800587 variants of the IL1A gene were associated with the severity of LDD and Modic changes. The rs41270041 variant of the ADAMTS4 gene and the rs226794 variant of the ADAMTS5 gene were associated with severity of LDD while the rs34884997 variant of the ADAMTS4 gene, the rs55933916 variant of the ADAMTS5 gene and the rs9862 variant of the TIMP3 gene were associated with severity of Modic changes. The rs17561 variant of the IL1A gene was predicted as pathogenic by the PolyPhen prediction tool.ConclusionsSNVs of candidate genes in ACAN metabolic pathway are associated with severity of LDD and Modic changes in patients with chronic mechanical low back pain. Predictions of in-silico functional analysis of significant SNVs are inconsistent.

Correlation of Vitamin D and Body Mass Index with Modic Changes in Patients with Non-Specific Low Back Pain in a Sub-Tropical Asian Population.

Study DesignCross-sectional study by non-probability consecutive sampling.PurposeThe objective of this study was to assess body mass index (BMI) and investigate vitamin D levels in patients with low back pain (LBP) and study a possible relationship with myopathy-related symptoms and Modic changes.Overview of LiteratureLBP is a multifactorial problem and the search for its patho-anatomical causes is ongoing. Modic changes seem to be a cause of back pain but the pathological mechanisms underlying this are not completely defined. Hypovitaminosis D and obesity have also been shown to cause chronic musculoskeletal pain. The relationship between vitamin D deficiency and BMI with Modic changes has not been studied in detail.MethodsThree hundred and sixteen patients with chronic LBP was selected for the study by non-probability consecutive sampling. The study was conducted over a period of 12 months from January 2014 to December 2014 at St. John's Medical College, Banglore. Questionnaires were provided to the participants and demographic information, symptoms, weight and height were recorded from the study subjects. BMI was calculated. Serum vitamin D level was assessed and Modic changes studied on magnetic resonance imaging. Correlations between vitamin D, BMI and Modic changes were studied using correlation coefficients and odds ratios obtained from logistic regression.ResultsTwo hundred and fifty-six out of 316 patients (80%) had low vitamin D. 83% of patients with BMI>25 kg/m2 had low vitamin D levels as compared to 69% with BMI<25 kg/m2. Statistically significant correlation coefficients were found between vitamin D levels, BMI and Modic changes. Significant association was found between low vitamin D levels and Modic changes (odds ratio 1.75).ConclusionsVitamin D deficiency and obesity have significant relations with LBP. Low vitamin D levels is associated with Modic changes but whether they represent a subgroup of patients whose low backpain is associated with low vitamin D needs to be further evaluated.

Frequency of Vertebral Endplate Modic Changes in Patients with Unstable Lumbar Spine and Its Effect on Surgical Outcome.

Study DesignProspective cohort study.PurposeIn this study, we investigated the frequency of vertebral endplate Modic changes (MCs) and their effects on surgical outcomes in patients with unstable lumbar spines.Overview of LiteratureSignal changes in endplates have been classified into three types by Modic. The prognostic role of MCs has been investigated in various spinal disorders.MethodsA series of 70 patients with clinical and radiographic unstable lumbar spine were included in the study. Endplate signal intensity was determined according to Modic classification. All patients underwent instrumented posterolateral fusion. Functional evaluation was made using the visual analog scale (VAS) and Oswestry disability index (ODI).ResultsEighteen patients (26%) had normal endplate intensity, 31 patients (44%) had MC type I, 20 patients (28%) had MC type II, and one patient (1.4%) had MC type III. Pain level VAS and ODI decreased significantly from the preoperative evaluation to the six-month and one-year postoperative evaluations. The surgical outcome (VAS and ODI) was not significantly different between the various types of MC.ConclusionsPosterolateral fusion is an effective treatment in patients with unstable lumbar spines. MC do not have a significant effect on the surgical outcome of these patients.

Modic changes in patients with degenerative diseases of the lumbar spine

Since the introduction of MRI for the assessment of degenerative pathologies of the lumbar spine, the bone marrow changes adjacent to the vertebral endplates, as described by Modic in 1984, are well known: There are three types of changes, and this classification has been accepted internationally by radiologists and spine surgeons, i.e. orthopaedic surgeons, as well as neurosurgeons treating routinely degenerative disc disease. Jones et al and Mulconrey et al reported a kappa value of 0.85 and 0.7 respectively for the interobserver reliability of these bone marrow changes.

Understanding end plate changes associated with disc surgery

Purpose of study: As disc arthroplasty for the treatment of degenerative disc disease becomes more prevalent, questions are beginning to arise as to the possible effects that these devices may have on the vertebral end plates. The end plate changes seen on magnetic resonance imaging (MRI) films after disc surgery usually come in two forms: they can either appear as anatomical changes to the configuration to the cartilage/vertebral body, or the changes can manifest themselves through differential signal intensities on MRIs. These latter types of abnormalities, Modic changes, represent an alteration in the vascularity and fat content of the bone marrow. End plate remodeling and Modic changes are thought to occur in the response to a number of factors, including natural degeneration of the disc or bone, infection within or around the disc or adjustments of the vertebrae in response to changes in load pressures. Both end plate remodeling and Modic changes typically occur after most types of surgical procedures to the disc, such as decompression, discectomy and fusion. Although end plate remodeling and Modic changes are common, their long-term clinical significance is not well understood. The intent of this study is to document the short- and long-term effects of prosthetic nucleus devices on the vertebral end plates.Methods used: In this retrospective study we followed 60 patients implanted with PDN prosthetic disc-nucleus devices (Raymedica, Inc.) for a period of 12 months. Preoperative MRI films were compared with 6-week through 12-month follow-up images.of findings: Of the 60 patients examined, 67% showed some degree of postoperative end plate remodeling and/or Modic change. Early in the follow-up process, none of the changes could be correlated with any clinical symptoms, and MRI done at the 12-month follow-up showed that for the most patients the changes had stabilized. There were three cases where end plate remodeling continued to a degree that resulted in significant disc-height narrowing.Relationship between findings and existing knowledge: The presence of end plate remodeling and Modic changes in patients implanted with prosthetic nucleus devices is not unexpected given that this type of change is commonly seen after surgical procedures affecting the disc. The results are also in agreement with the concept that bone will remodel in response to changes in stress (Wolff's law).Overall significance of findings: Although vertebral body and end plate radiographic changes do occur in some patients implanted with PDN devices, these changes usually stabilize over time and rarely lead to clinical sequelae. Therefore, treatment decisions based on the presence of postoperative radiographic changes should not be made unless the changes can be correlated to clinical signs and symptoms.Disclosures: Device or drug: PDN prosthetic disc-nucleus device. Status: investigational.Conflict of interest: Rick Vazquez, employee of Raymedica Inc.; Mark Myers, consultant, Raymedica Inc.