Prevalence Of Modic Changes Research Articles

The effect of long-term alendronic acid treatment on Modic changes in the lumbar spine: a gender and age-matched study

BackgroundLow back pain (LBP) affects a significant proportion of the adult population. Potent anti-resorptive drugs such as intravenous zoledronic acid have been demonstrated to reduce Modic changes (MCs) upon magnetic resonance imaging (MRI) of the spine and concomitantly decrease associated LBP. It is uncertain whether oral alendronic acid has a similar effect.Methods82 subjects were recruited in this case-control study. Treatment subjects (n = 41) received oral alendronic acid treatment for at least 1-year and were matched by gender and age (± 2) to control subjects (n = 41) not receiving any anti-osteoporotic medication. The prevalence, type, and extent of MCs were quantified upon T1 and T2-weighted MRIs of the lumbosacral spine.ResultsTreatment subjects received oral alendronic acid for 124.0 ± 62.1 weeks at the time of MRI assessment and exhibited a lower prevalence of MCs over the lumbosacral spine (18/41 vs. 30/41, p < 0.001) as compared to control subjects. Amongst both groups, type 2 MCs were predominant. Quantification of type 2 MCs in treatment subjects revealed a significant reduction in area (113 ± 106 mm2 vs. 231 ± 144 mm2, p < 0.01) and volume (453 ± 427 mm3 vs. 925 ± 575 mm3, p < 0.01) affected by type 2 MCs in comparison to matched controls.ConclusionOral alendronic acid may be useful in the treatment of MC-associated LBP in patients with concomitant osteoporosis.

Modic changes in the lumbar vertebral column of chondrodystrophic and non-chondrodystrophic dogs with intervertebral disc disease.

Modic changes (MC) are signs of vertebral pathology visible on magnetic resonance (MR) images that have been associated with low back pain (LBP) and disc degeneration in people. Multiple breeds of dogs also develop MCs and coincident back pain. However, the association between breed, MC, and spinal pathologies has yet to be fully elucidated. This study aimed to identify the prevalence of MC that occur spontaneously in the lumbar vertebral column of dogs diagnosed with intervertebral disc disease (IVDD) and examine their association with demographic criteria and the disc width index (DWI). Medical records and lumbar vertebral column MR images were examined from 104 dogs (831 intervertebral disc spaces and adjacent vertebrae), which were divided into three groups: chondrodystrophic dogs (CD; n =54) and non-chondrodystrophic dogs (NCD; n =30) with IVDD as the primary diagnosis, and control dogs (n =20) with other spinal diseases as their primary diagnosis. Increasing age and a diagnosis of IVDD were significantly associated with MC in dogs (p < 0.001 and p = 0.0062, respectively). In CD dogs with IVDD, Type 2 MC were most prevalent, whereas, in NCD dogs, Type 3 MC were the most prevalent type. Type 2 MC were distributed nearly equally across the lumbar vertebral column, while Type 3 MC were primarily detected at the level of L7-S1. This study demonstrated that MC developed spontaneously in dogs, are common in dogs diagnosed with IVDD, and the type observed varies by breed. Further research is needed to understand the pathogenesis of MC; however, the increased presence of Type 2 MC in CD dogs, similar to what is found in people with disc degeneration, suggests that CD dogs could serve as models for MC in people.

Postoperative Sclerotic Modic Changes After Transforaminal Lumbar Interbody Fusion: The Prevalence, Risk Factors, and Impact on Fusion.

A retrospective cohort study. This study aimed to assess postoperative sclerotic modic changes (MCs) following transforaminal lumbar interbody fusion for lumbar degenerative disc disease, investigating their prevalence, risk factors, and association with clinical outcomes. Sclerotic MCs may occur in patients with lumbar degenerative disc disease after lumbar interbody fusion. The incidence and characteristics of postoperative sclerotic MCs, as well as their clinical impact, are unknown. The study included 467 patients (510 levels) who underwent single or two-level transforaminal lumbar interbody fusion surgery, divided into a postoperative sclerotic MC group (60 patients, 66 levels) and a non-MC group (407 patients, 444 levels). The time of development and location of postoperative sclerotic MCs, fusion rate, cage subsidence, bilateral process decompression, and cross-link usage were recorded. Preoperative, postoperative, and follow-up visual analogue scale and Oswestry disability index scores were collected. Multivariable logistic regression was used to evaluate factors associated with the development of postoperative sclerotic MCs. The prevalence of postoperative sclerotic MCs was 12.8%. The postoperative sclerotic MC group had a higher body mass index (BMI). The postoperative sclerotic MC group demonstrated a fusion rate of 47%, significantly lower than that of the non-MC group (71%) at six months post-operation. At final follow-up, the fusion rate in the postoperative sclerotic MC group was 62%, significantly lower than that of the non-MC group (86%). Postoperative visual analogue scale and Oswestry disability index scores were significantly higher in the group with postoperative sclerotic MCs. BMI and osteoporosis were significantly associated with the development of postoperative sclerotic MCs. Postoperative sclerotic MCs generally appear within the first year after surgery, with a prevalence of 12.8%. The presence of postoperative sclerotic MCs can adversely impact postoperative outcomes. To prevent postoperative sclerotic MCs, the authors postulate extending the immobilization period with external bracing and improving the management of BMI and osteoporosis in the perioperative time window.

Prevalence and Risk Factors for Modic Changes in Symptomatic Cervical Ossification of the Posterior Longitudinal Ligament: A Retrospective Study of 203 Patients.

BACKGROUND Modic changes (MC) are abnormal bone signals under the vertebral endplates on magnetic resonance imaging (MRI) of the spine. Three types of MC may be seen on MRI as abnormal bone signals of the vertebral endplate and adjacent bone marrow. This retrospective study of 203 patients with symptomatic cervical ossification of the posterior longitudinal ligament (OPLL) aimed to evaluate factors associated with MC on cervical spine MRI. MATERIAL AND METHODS We included 203 patients with symptomatic cervical ossification of the OPLL. All patients underwent MRI with T1 and T2 sequences to assess the presence and type of MC. Univariate and multivariate logistic regression analyses were used to identify the risk factors for MC. RESULTS The prevalence of MC in patients with symptomatic cervical OPLL was 21.18%. Type 2 MC accounted for 88.64% of the cases. Local type and MC share the same segment (100.00%), followed by segmental type (77.27%), mixed type (75.00%), and continuous type (75.00%). Age (OR=1.05, 95% CI: 1.01-1.09, P=0.013) and neck pain (OR=2.67, 95% CI: 1.04-6.83, P=0.041) were significantly correlated with MC. Further receiver operating characteristic (ROC) analysis displayed an area under the curve (AUC) of 0.657 (P=0.002) for age, and the optimal cutoff was 60.50 years (sensitivity 0.67, specificity 0.68). CONCLUSIONS The results of this study found that older age and neck pain were significantly associated with development of cervical spine MC. Patients ≥60.5 years with symptomatic cervical OPLL had a higher probability of developing MC.

The disc-endplate-bone-marrow complex classification: progress in our understanding of Modic vertebral endplate changes and their clinical relevance

Background contextThe disc, endplate (EP), and bone marrow region of the spine form a single anatomical and functional interdependent unit; isolated degeneration of any one structure is rare. Modic changes (MC), however, are restricted to the subchondral bone alone and based on only T1 and T2 sequences of MRI. This results in poor reliability in differentiating fat from edema and hence may give a false impression of disease inactivity. PurposeTo study the changes in disc, endplate, and bone marrow as a whole in degeneration and propose a classification based on the activity status of this complex with the addition of STIR MRI sequences. Study designObservational cohort. Patient samplePatients with isolated brain, cervical, or thoracic spine injury and patients with low back pain (LBP) who underwent MRI formed the control and study groups, respectively. Outcome measuresDemographic data, the prevalence of MC and disc-endplate-bone marrow classification (DEBC) changes, EPs undergoing reclassification based on DEBC, and comparison of the prevalence of MC, DEBC, H+modifier and DEBC with H+concordance between control and LBP group. The study determined the risk of LBP patients undergoing surgery as well as the incidence of postoperative infection based on DEBC changes. Significance was calculated by binomial test and chi-square test with the effect size of 0.3 to 0.5. Prevalence and association of outcome were calculated by Altman's odds ratio with the 95% CI and the scoring of z statistics. Logistic expression was plotted for independent variables associated with each class of both Modic and DEBC against dependent variables surgery and nonsurgery. MethodsLumbar segments in both groups were assessed for MC types. The DEBC classification was developed with the addition of STIR images and studying the interdependent complex as a whole: type-A: acute inflammation; type-B: chronic persistence; type-C: latent and type-D: inactive. Modifier H+ was added if there was disc herniation. The classification was compared with MC and correlated to clinical outcomes. ResultsA total of 3,560 EPs of 445 controls and 8,680 EPs in 1,085 patients with LBP were assessed. Four nonMC, 560 MC-II, and 22 MC-III EPs were found to have previously undetected edema in STIR (n=542) or hyperintensity in discs (n=44) needing reclassification. The formerly undescribed type-B of DEBC, representing a chronic persistent activity state was the most common (51.8%) type. The difference between the control and LBP of H+(12% vs 28.8%) and its co-occurrence with DEBC type 1.1% vs 23.3%) was significant (p<.0001). The odds ratio for the need for surgery was highest (OR=5.2) when H+ and DEBC type change co-occurred. Postoperative deep infection (as determined by CDC criteria) was 0.47% in nonDEBC, compared with 2.4% in patients with DEBC (p=.002), with maximum occurrence in type-B. ConclusionClassification based on the classic MC was found to need a reclassification in 586 EPs showing the shortcomings of results of previous studies. Considering the DEBC allowed better classification and better predictability for the need for surgical intervention and incidence of postoperative infection rate than MC.

Modic change is associated with increased BMI but not autoimmune diseases in TwinsUK

PurposeLow back pain (LBP) is one of the largest causes of morbidity worldwide. The aetiology of LBP is complex, and many factors contribute to the onset. Bone marrow lesions within the vertebra adjacent to an intervertebral degenerate disc named Modic change (MC) have been suggested as a diagnostic subgroup of LBP. Autoimmune response has been proposed to be one of the causes that promote the development of MC. The aim of the current investigation is to assess prevalence and severity of MC and LBP in participants with an autoimmune disease diagnosis in a well-documented cohort of adult twin volunteers. MethodsMultivariate generalized mixed linear models (GLMM) were implemented in order to calculate the association between having an autoimmune disorder and MC prevalence, width and severe and disabling LBP. The model was corrected for family structure as well as for covariates such as age, BMI and smoking.ResultsNo association was found between diagnosis of autoimmune disorder and MC. Interestingly, BMI was independently associated with MC width but not to MC prevalence. These results help to shed light on the relationship between MC and autoimmunity as well as the role of BMI in the development of the lesions.ConclusionThis study is the first to examine autoimmune disorders and MC prevalence in a large, population-based female cohort. The study was well powered to detect a small effect. No association was found between having a diagnosis of one or more autoimmune conditions and MC prevalence, width or LBP.

Disc degeneration is easily occurred at the same and adjacent cephalad level in cervical spine when Modic changes are present

ObjectiveThis research aimed to evaluate the influence of Modic changes (MCs) on disc degeneration at the same and adjacent cephalad levels in the cervical spine.MethodsThis research retrospectively reviewed 1036 patients with neck pain, upper limb pain, or numbness who were treated at our out-patient clinic and underwent cervical MRI and cervical anteroposterior/lateral radiography from Jan, 2016 to Jan, 2021. MCs and disc degeneration parameters at same and nearby cephalad levels of MCs were evaluated. Discs were divided into the MCs, adjacent, and control groups, and the association between MCs and disc degeneration at the same and adjacent cephalad levels was investigated.ResultsOf the 1036 patients whose MRI scans were reviewed, 986 met the inclusion criteria (503 women and 483 men; average age, 62.8 years; scope of 35–79 years). The prevalence of MCs in the cervical spine was 13.0% (128/986). Type I, II, III changes were observed in 38 (29.69%), 82 (64.06%), and 8 (6.25%) patients, respectively. MCs were most frequently identified at the C5–6 (59/986; 5.98%) and C6–7 (38/986; 3.85%) levels. Disc with MCs showed worse outcomes with regard to disc degeneration grade, anterior osteophyte formation than the adjacent and control groups (p < 0.05), whereas they were more severe in the adjacent group compared to normal group.ConclusionOur findings indicate that MCs increased disc degeneration at the same and nearby cephalad levels in cervical spine, and the severity of degeneration at the same segment was more serious than that at the cephalad level.

Epidemiology of Modic changes in dogs: Prevalence, possible risk factors, and association with spinal phenotypes.

Chronic low back pain, a leading contributor to disease burden worldwide, is often caused by intervertebral disc (IVD) degeneration. Modic changes (MCs) are MRI signal intensity changes due to lesions in vertebral bone marrow adjacent to degenerated IVDs. Only a few studies described the histopathological changes associated with MC to date. MC type 1 is suggestedto be associated with bone marrow infiltration of fibrovascular tissue, type 2 with fatty infiltration, and type 3 with bone sclerosis in humans. This study investigated whether the dog can be a valuable animal model to research MCs, by examining the prevalence, imaging, and histological characteristics of lumbar MCs in dogs (340 dogs, 2496 spinal segments). Logistic regression analysis indicated that the presence of lumbosacral MCs was associated with age and disc herniation (annulus fibrosis protrusion and/or nucleus pulposus extrusion). According to MRI analysis, MCs were mostly detected at the lumbosacral junction in dogs. Most signal intensity changes represented MC type 3, while previous spinal surgery seemed to predispose for the development of MC type 1 and 2. Histological analysis (16 dogs, 39 spinal segments) indicated that IVDs with MCs showed more histopathological abnormalities in the endplate and vertebral bone marrow than IVDs without MCs. Mostly chondroid proliferation in the bone marrow was encountered, while the histologic anomalies described in humans associated with MCs, such as fibrovascular or fatty infiltration, were scarcely detected. Dogs spontaneously develop MCs, but may exhibit other pathological processes or more chronic bone marrow pathologies than humans with MCs. Therefore, more research is needed to determine the translatability of the MCs encountered in dog low-back-pain patients.

Distribution of modic changes and its relation with age, sex and body mass index in Iranian population

BackgroundSuspected as a cause of low back pain (LBP), Modic changes (MCs) have received increasing attention in spine research and care. Knowledge of MCs based on the general population, which may provide an important clinical reference is limited. Moreover, fewer studies have examined whether MCs are related to other structural features of LBP, such as age, gender and body mass index (BMI). The aim of present study was to determine the prevalence and clinical distribution of MCs in patients with LBP and to explore the related factors such as age, gender and BMI. MethodA total of 159 adult subjects (74 males [46.2%] and 85 females [53.5%]) were enrolled in the study (Mean age: 46.15 ± 10.36) and scanned with 1.5 T Magnetic Resonance Scanner. Age, gender, disk degeneration, herniation, involved segments, Lumbar lordosis (LL) angle, Sacral sloop (SS), MCs, and endplate concave angle (ECA) were recorded. Disk degeneration was graded using a Pfirrmann scale. MCs were classified into Type I (MCI), type II (MC II), type III (MCIII). ResultsThere were a total of 13 patients (8.2%) with MCI, 145 patients (91.2%) with MC II, and 1 patient (0.6%) with MCIII. Among all patients, the L4/L5 lumbar level was most likely to suffer MCs (56.0%). Greater age [odds ratio (OR) = 2.44 for each 10-year increase] and BMI (OR = 1.07) were associated with the presence of MCs. Logistic regression showed that age, LL, L5/S1 segment lordosis angle, and L5 upper and lower ECA were related with different types of MCs. The OR values were A = 1.08, L = 0.88, D = 1.12, E = 0.88, O = 1.10, respectively (A means age, L means L5/S1 segment lordosis angle, D and E means L5 upper and lower ECA and O means Lumbar lordosis). ConclusionType II MCs are predominant, mostly occur in lower lumbar region. Age, LL, and L5 ECA were associated with type II MCs. L5 Lower concave angle and LL were the most relevant factors for different types.

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.

Correlation between intervertebral disc degeneration and bone mineral density difference: a retrospective study of postmenopausal women using an eight-level MRI-based disc degeneration grading system

PurposeTo explore the correlation between intervertebral disc degeneration (IDD) and bone mineral density (BMD) difference between adjacent vertebrae.MethodsA retrospective analysis of 114 postmenopausal women who were treated in our hospital from January 2021 to December 2021. The degree of lumbar(L)1–5 IDD was scored according to an 8-grade scoring system. The lumbar vertebrae BMD was detected, and the BMD difference was calculated. The subjects were grouped according to age and whether the disc was severe IDD. Data were collected for statistical analysis.ResultsThe prevalence of osteoporosis in the 51–60-year-old group was lower than that in the other groups, while the prevalence of modic changes in the 71–80-year-old group was higher than that in the 51–70-year-old group (P < 0.05). At the L1/2 level, the prevalence of severe IDD in the 81-90y group was higher than that in the 51-70y group (P < 0.05). At the L2/3 level, the prevalence of severe IDD in the 71-90y group was higher than that in the 51-60y group, and the prevalence of severe IDD in the 71-80y group was higher than that in the 61-70y group (P < 0.05). The L2/3 disc score was positively correlated with the L3-L2 BMD difference (P < 0.05). At the level of L1-2, the BMD difference in the non-severe IDD group was smaller than that in the severe IDD group (P < 0.05).ConclusionFor postmenopausal women, an increase in BMD difference is correlated with IDD. Osteoporosis is more common in people over 60 years old, and the possibility of modic change in 71-80y is higher than in other age groups. The incidence of severe IDD also increases with aging, especially for the L1/2 and L2/3 discs.

The effect of transitional vertebrae and spina bifida occulta on disc herniation, disc degeneration, and end-plate changes in pediatric patients with low back pain.

The aim of the study is to investigate the assumption whether lumbosacral transitional vertebrae (LSTV) and spina bifida occulta (SBO) cause lumbar disc herniation (LDH), intervertebral disc degeneration (IDD), and vertebral endplate changes / Modic changes (MCs) in children and adolescents with low back pain (LBP). Four hundred patients (aged 10-17) with LBP persisting for at least six weeks were included in the study. Lumbosacral X-rays were examined for the presence of LSTV and SBO. The prevalence of IDD/MCs and LDH at L4-5 and L5-S1 levels were investigated by evaluating the lumbosacral MRI of the patients with and without LSTV-SBO. The study population consisted of 219 girls and 181 boys with mean age 14.9±1.9. LSTV was determined in 67 (16.8%) patients and SBO in 62 (15.5%). No significant difference was observed in the prevalence of IDD, MCs, and LDH in patients with and without LSTV/SBO. LSTV and SBO were not observed in approximately 80% of patients without LDH and IDD/MCs. The presence of LSTV and SBO does not appear to represent a risk factor for early degeneration in lumbar spine and LDH in children and adolescents with LBP.

Modic changes and its association with other MRI phenotypes in east Anatolian low back pain patients

Objective Modic changes (MCs) are known to be associated with low back pain (LBP). Literature contains conflicting reports about the prevalence of MCs and other spinal phenotypes among different populations with LBP patients. We aimed to evaluate the prevalence of MCs in the lumbar spine and associated features in Eastern Anatolian chronic LBP patients. Methods The study sample comprised of 786 consecutive patients [(490 female, 296 male), (mean age 39.7; range 20–78)] with a history of low back pain for at least 3 months. Data about MCs involvement, Schmorl’s nodes (SN), disc degeneration (DD), disc displacement, disc height and osteophytes were obtained via MRI. Patients’ demographic characteristics, Oswestry disability index (ODI) and visual analog scale (VAS) scores were assessed using a questionnaire. Results MCs were present in 67.2% (528/786) of the patients. Of all evaluated lumbar-level changes, 86 (6.2%) were Type I, 991 (76.8%) were Type II, 11 (0.8%) were Type III, 47 (6.5%) were Type II/III, 89 (8.5%) were Type I/II, and 29 (1.2%) were Type I/II/III MCs. MCs were significantly associated with severe DD (p < 0.001), disc displacement (p < 0.001), SN (p < 0.001), and osteophytes (p < 0.001). In the multivariate regression analysis, BMI (for both ODI and VAS) and age (only for ODI) were the only independent predictors of clinical severity. Conclusions The present study is the largest cross-sectional study of adult members of the Eastern Anatolian population with chronic LBP. Modic changes were detected in 67.2% of patients with chronic LBP and the prevalence of other phenotypic features differed significantly between MCs and non-MCs disc levels. Nevertheless, the results of the current study do not support a causal relationship of MCs or any MRI changes with clinical symptom severity.

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.

Role of growth plate (apophyseal ring fracture) in causing modic type changes in pediatric low back pain patients.

We investigated the prevalence of Modic changes (MCs) and associated pathologies in pediatric patients. A total of 368 MRI obtained for 240 male and 128 female patients under the age of 18years with complaints of low back/leg pain were retrospectively examined. All changes in signal intensity in the vertebral endplate and subchondral bone on MRI were defined as MCs. We investigated the relationship between MCs and underlying diseases, including lumbar spondylolysis/spondylolisthesis, and conditions of the growth plate in cases with MCs. The degree of disc degeneration in patients with MCs was evaluated using the Pfirrmann grading system. MCs were identified in six patients (1.6%). In five of the six patients, the signal intensity changes were localized to the anterosuperior endplate of the affected vertebra; the MCs were associated with anterior apophyseal ring fracture and an open growth plate in all these cases. Disc degeneration was classified as Pfirrmann grade I in three patients and grade II and III in one patient each. One patient had type I changes associated with grade IV disc degeneration and herniation and no sign of an open growth plate. The prevalence of MCs in pediatrics patients was much lower than the rates reported in adults. Most MCs were associated with an anterior apophyseal ring fracture. If Modic type changes are seen in immature vertebrae of pediatric patients, growth plate lesions such as apophyseal ring fractures should be considered. Diagnostic: individual l cross-sectional studies with consistently applied reference standard and blinding.

Modic Change and Clinical Assessment Scores in Patients Undergoing Lumbar Surgery for Disk Herniation.

Retrospective cohort study. To examine the relationship between preoperative Modic change (MC) and postoperative clinical assessment scores for patients receiving lumbar discectomy or transforaminal lumbar interbody fusion for lumbar disk herniation. Lumbar disk herniation is a risk factor for MC development. MC on spinal magnetic resonance imaging (MRI) has been associated with worse preoperative and postoperative clinical assessment scores. We reviewed data for 285 primary single-level surgeries. Preoperative and 12-month postoperative assessment scores were recorded using the visual analog scale leg pain, Oswestry Disability Index, and Short Form-36 Physical Component Summary. MC subgroup on preoperative MRI was recorded by a single neuroradiologist. One hundred seventy-nine patients (female, 56%; age-53±13 y) with preoperative MRI were included. Age and sex were similar across MC subgroups. The sample prevalence of MC on preoperative MRI was 62%, and MC2 was the most common subgroup (35%). No differences in preoperative assessment scores were identified, regardless of presence or absence of MC. For the overall cohort, improvement in assessment scores were observed: Short Form-36 improved an average of 8.2 points [95% CI (95% CI), 5.8-10.7], Oswestry Disability Index by 11.3 points (95% CI, 8.7-14.0), and visual analog scale by 2.8 points (95% CI, 2.1-3.5). In nearly all cases, MCID values were met, even when stratifying by MC subgroup. Few differences in postoperative assessment scores were identified when comparing across MC1, MC2, or no MC groups. Statistically and clinically significant improvement in postoperative clinical assessment scores was observed for both lumbar discectomy and transforaminal lumbar interbody fusion groups. MC on preoperative MRI was not associated with worse preoperative or postoperative clinical assessment scores. Level III.

Presence of preoperative Modic changes and severity of endplate damagescore are independent risk factors for developing postoperative surgical site infection: a retrospective case-control study of 1124 patients.

There is increasing evidence of an association between Modic changes (MC) and subclinical infection. However, the association of MC with postoperative surgical site infection (SSI) has not been adequately probed. This study primarily aimed to investigate a probable association between preoperative MC, total endplate damage score (TEPS), and SSI. A retrospective analysis of 1124 patients who underwent surgery in a single institution (2016-2018) was performed, using both univariate and multiple logistic regression analyses to identify independent risk factors for SSI. The prevalence of SSI was 4% (44/1124 patients), with no association with age or sex. The prevalence of MC in the SSI group was significantly higher-79.54% (35/44) compared to 58.79% (635/1080) (p value = 0.006) in the control group with no specific relation to type or location of MC. A higher TEPS was associated with SSI (p value = 0.009). A receiver operating characteristic (ROC) curve for TEPS values to assess predictiveness of SSI showed TEPS ≥ 5.5 to have a better sensitivity of 84% than 72% for a TEPS ≥ 6.5. Univariate analysis showed TEPS > 6 (odds ratio 3.887) to have a stronger association with SSI than the presence of MC (odds ratio 2.725). Among various types of surgeries, discectomy had a higher association with SSI (p value = 0.03) when compared to fusion (p value = 0.071). However, multiple logistic regression analysis revealed only TEPS > 6, presence of MC and hypothyroidism as independent risk factors for SSI. Our data suggest that preoperative MC and TEPS > 6 are independent risk factors for developing surgical site infections. MC could be foci of chronic subclinical infection and not mere markers of degeneration, as initially described.

Are Modic Vertebral End-Plate Signal Changes Associated with Degeneration or Clinical Outcomes in the Cervical Spine?

To report on the incidence of Modic changes (MCs) in patients with cervical radiculopathy due to a herniated disc. Presence of MCs was correlated to clinical outcomes and the presence of radiological degeneration. Patients that underwent anterior discectomy for a cervical radiculopathy due to a herniating disc were analyzed for the presence of MCs at baseline and at 1-year follow-up after surgery. Neck Disability Index, physical component summary, mental component summary, and visual analog scale for neck pain and for arm pain were evaluated as clinical outcomes. The presence of radiological degeneration was defined by the method of Goffin. The prevalence of MCs was found at 18% at baseline and increased to 28% one year after surgery. Both at baseline and at 1-year follow-up, the percentage of patients with and without MCs reporting neck pain was comparable. Likewise, both at baseline and at 1-year follow-up, the percentage of patients with and without MCs reporting disabling arm pain was comparable. At baseline, the patients with MC demonstrated more radiologic degeneration than those without MC (OR 0.42), but this difference disappeared at 1 year after surgery. MCs were not associated with neck pain, nor with arm pain. Furthermore, there was a tendency for a correlation between the presence of MCs and radiological degeneration.

Latent infection of low-virulence anaerobic bacteria in degenerated lumbar intervertebral discs

BackgroundThe existence of latent low-virulence anaerobic bacteria in degenerated intervertebral discs (IVDs) remains controversial. In this study, the prevalence of low-virulence anaerobic bacteria in degenerated IVDs was examined, and the correlation between bacterial infection and clinical symptoms was analysed.MethodsEighty patients with disc herniation who underwent discectomy were included in this study. Under a stringent protocol to ensure sterile conditions, 80 disc samples were intraoperatively retrieved and subjected to microbiological culture. Meanwhile, tissue samples from the surrounding muscle and ligaments were harvested and cultured as contamination markers. The severity of IVD degeneration and the prevalence of Modic changes (MCs) were assessed according to preoperative MRI analysis.ResultsOf the 80 cultured discs, 54 were sterile, and 26 showed the presence of bacteria: Propionibacterium acnes (21 cases) and coagulase-negative staphylococci (5 cases). MRI revealed that the presence of bacteria was significantly associated with MCs (P<0.001). However, there was no significant association between bacterial infection and the severity of IVD degeneration (P = 0.162).ConclusionsOur findings further validated the presence of low-virulence anaerobic bacteria in degenerated IVDs, and P. acnes was the most frequent bacterium. In addition, the latent infection of bacteria in IVDs was associated with Modic changes. Therefore, low-virulence anaerobic bacteria may play a crucial role in the pathophysiology of MCs and lumbar disc herniation.

Strong association between vertebral endplate defect and Modic change in the general population

Modic change (MC) is considered an independent risk factor for low back pain (LBP) but its aetiology remains unclear. In this cross-sectional, large-scale population-based study we sought to characterise associations between endplate defect (ED) and MC in a population sample of broad age range. The study population consisted of 831 twin volunteers (including 4155 discs and 8310 endplates) from TwinsUK. Lumbar T2-weighted MR images were coded for ED and MC. Total endplate (TEP) score was calculated at each intervertebral disc while receiver operating curves (ROC) were calculated to define critical endplate values predictive of MC. MC was detected in 32.1% of the subjects, with a significantly higher prevalence at lower lumbar levels (3.5% at L1/2-L3/4 vs. 15.9% at L4/5-L5/S1, p < 0.001). TEP score was strongly and independently associated with MC at each lumbar level (risk estimates from 1.49 to 2.44; all p ≤ 0.001) after adjustment for age, sex, BMI and twin pairing. ROC analysis showed a TEP score cut-off of 6 above which there was a significantly higher prevalence of MC. In conclusion, ED were strongly associated with MC at every lumbar level. These findings support the hypothesis that endplate defect is a major initiating factor for the cascade of events that may include disc degeneration (DD) and MC.