Study Design. A cross-sectional study of the Northern Finland Birth Cohort 1966 (NFBC1966). Objective. The aim of this study was to evaluate the association between the type, size, and location of lumbar Modic changes (MC), and prolonged disabling low back pain (LBP). Summary of Background Data. LBP is the leading cause of disability worldwide and it affects all age- and socioeconomical groups. Only a small proportion of LBP patients are diagnosed with a specific cause: In most cases no single nociceptive cause for the pain can be identified. MC are visualized in magnetic resonance imaging (MRI) as a signal intensity change in vertebral bone marrow and have been proposed to represent a specific degenerative imaging phenotype associated with LBP. MC can be classified into several subtypes, of which inflammatory Type 1 (MC1) is suggested as being more likely to be associated with LBP. Methods. We assessed lumbar MRI (n = 1512) for the presence, type, and size of MC. The associations of MC characteristics with prolonged (≥30 days during the past year) and disabling (bothersomeness of LBP at least 6 on a 0–10 Numeric Rating Scale) LBP, evaluated at the time of imaging at 47 years, were analyzed using binary logistic regression, adjusted for sex, BMI, smoking, educational status, lumbar disc degeneration, and disc herniations. Results. Any MC and MC1 were associated with prolonged disabling LBP (odds ratio [OR] after full adjustments 1.50 [95% confidence interval, CI 1.05–2.15] and 1.50 [95% CI 1.10–2.05], respectively). Furthermore, MC covering the whole anterior-posterior direction or the whole endplate, as well as the height of MC, were significantly associated with prolonged disabling LBP (OR after full adjustments 1.59 [95% CI 1.14–2.20], 1.67 [95% CI 1.13–2.46] and 1.26 [95% CI 1.13–1.42], respectively). Conclusion. Our study showed a significant and independent association between MC and clinically relevant LBP. Level of Evidence: 3
Population-based birth cohort study.Objective. The aim of this study was to evaluate the relationship between vertebral dimensions and lumbar MC. Summary of Background Data. Low back pain (LBP) has become the leading cause of disability worldwide. Modic changes (MC) of the lumbar spine are one potential LBPassociated etiological factor. Mechanical stress is considered to play a key role in the development of MC through damage to endplates. There is speculation that vertebral dimensions play a role in some degenerative changes in the spine. Previous studies have also shown a positive association between moderate-tovigorous physical activity (MVPA) and both vertebral dimensions and MC. In this study, we aimed to evaluate the relationship between vertebral dimensions and MC. Methods. The study population consisted of 1221 participants from the Northern Finland Birth Cohort 1966 who underwent lumbar magnetic resonance imaging (MRI) and physical activity measurements at the age of 46-48. The presence of Type 1 (MC1) and Type 2 (MC2) MC and the height, axial crosssectional area (CSA), and volume of the L4 vertebra were determined from MRI scans. MVPA (!3.5 metabolic equivalents) was measured by a wrist-worn accelerometer. We analyzed the association between lumbar MC and vertebral height, CSA, and volume using logistic regression models before and after adjustment for sex, height, weight, smoking, education level, and MVPA. Results. Vertebral height was positively associated with the presence of MC2 (odds ratio [OR] 3.51; 95% confidence interval [CI] 1.43-8.65), whereas vertebral CSA was not associated with the presence of lumbar MC. Vertebral volume was positively associated with the presence of any MC (OR 1.04; 95% CI 1.00-1.07), but the association did not persist when analyzing MC1 and MC2 separately. Conclusion. Vertebral height was associated with the presence of MC2. Further studies are needed to clarify the role of vertebral dimensions as independent risk factors for MC.
Background Modic changes (MC) in the lumbar spine are considered one potential etiological factor behind low back pain (LBP). Multiple risk factors for MC have been suggested, including male gender, smoking and factors affecting hyperloading and mechanical stress such as high body mass index (BMI), strenuous physical work and high occupational and leisure-time physical activity (PA). So far, the effect of PA on the occurrence of MC has remained under debate due to contradictory findings. The purpose of this study was to investigate the possible association between device-measured moderate-to-vigorous PA (MVPA) (≥ 3.5 METs) and lumbar MC. Methods The study had 1374 participants from the Northern Finland Birth Cohort 1966. At the age of 46–48, PA was measured by a wrist-worn accelerometer, and lumbar magnetic resonance imaging (MRI) was carried out to determine MC. We analyzed the association between Type 1 (MC1) and Type 2 (MC2) MC and daily amount of MVPA (min/day) using sex-stratified logistic regression models before and after adjustment for BMI, socioeconomic status, smoking, and accelerometer wear time. Results Among men, increased amount of MVPA was positively associated with any MC (adjusted OR corresponding to every 60 min/day of MVPA 1.41; 95% confidence interval (CI) 1.01 to 1.95) and MC2 (OR 1.54; 95% CI 1.14 to 2.08), but not with MC1 (OR 1.06; 95% CI 0.80 to 1.39). Among women, we only found a positive association between MVPA and MC1 before adjustments (unadjusted OR 1.42; 95% CI 1.06 to 1.92). Conclusion Among men, increased amount of MVPA was associated with increased odds of any MC and particularly MC2. Among women, MVPA was not independently associated with MC.
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