A Three-Year Follow-up of Lumbar Spine Endplate (Modic) Changes

Kuisma, Mari; Karppinen, Jaro; Niinimäki, Jaakko; Kurunlahti, Mauno; Haapea, Marianne; Vanharanta, Heikki; Tervonen, Osmo

doi:10.1097/01.brs.0000224167.18483.14

Cited by 180 publications

(184 citation statements)

References 15 publications

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“…An inflammatory process in endplates with M1 subchondral signal changes has been suggested to be induced by tumor necrosis factor (TNF) [18]. In a 3-year follow-up of sciatica patients [12], new subchondral signal abnormalities were seldom found to be associated with endplate lesions, in contrast to our study, but the follow-up was shorter and the prevalence of subchondral hypointensities was lower and none was uniformly hypointense at baseline.…”

Section: Discussioncontrasting

confidence: 93%

“…The finding of three new hypointensities appearing within previous hyperintensities may be explained by new subchondral edema in a region with earlier fatty degeneration. Reverse transformation of M2 to M1 has been reported earlier [12,14]. Thirty-four percent of M1s persisted or enlarged, suggesting that the phase of subchondral edema may last even for years.…”

Section: Discussionmentioning

confidence: 72%

“…Most follow-up studies on the natural course of subchondral signal abnormalities include patients with disc herniations [2,12,16,17,25].…”

Section: Introductionmentioning

confidence: 99%

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MRI follow-up of subchondral signal abnormalities in a selected group of chronic low back pain patients

et al. 2008

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Subchondral signal abnormalities have been suggested to play an important role in chronic low back pain (LBP) syndromes. Their natural course is not well known. In this study the morphology and natural course of isolated subchondral signal abnormalities in the lumbosacral spine were analyzed with MRI. Twenty-four chronic LBP patients with a subchondral hypointensity on T1-weighted image (hyperintense on T2), indicating edema, were selected from a base population of 1,015 consecutive LBP patients to a follow-up MRI study within 18-72 months. Exclusion criteria were age [60 years, nerve root compression, a more specific back disease or a recent or major spine operation. The size and location of each subchondral signal abnormality and endplate lesion and the degree of degenerative disc changes were evaluated and compared between the baseline and follow-up studies. Most subchondral hypointensities were found at the L4/L5 or L5/S1 disc space, anteriorly and in both adjacent endplates. Almost all (53/54) hypointensities were associated with an endplate lesion. Twelve of the 54 subchondral hypointensities enlarged, six remained constant and 36 decreased or disappeared while five new ones appeared. Twenty-two (41%) hypointensities changed totally to hyperintensities or to mixed lesions. If the hypointensity increased, decreased or changed into hyperintensity, a change tended to develop in the adjacent endplate. If the hypointensity was absent or unchanged, endplate lesions did not tend to progress. In the absence of disc herniation or other specific spinal disease, subchondral hypointensities indicating edema are uncommon. They seem to have a highly variable course. There appears to be a link between endplate lesions and subchondral signal abnormalities. Further study is needed to explain the contribution of these findings to low back symptoms.

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Section: Discussioncontrasting

confidence: 93%

Section: Discussionmentioning

confidence: 72%

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MRI follow-up of subchondral signal abnormalities in a selected group of chronic low back pain patients

et al. 2008

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“…Modic-associated proinflammatory biochemical mediators have been suggested to be a major origin of pain [6]. MT1 converts to either MT2 or to a normal stage from 14 months to 3 years [20]. However, one possible explanation is that the acute inflammation may have resolved, even though MT1 was still present on the MRI.…”

Section: Discussionmentioning

confidence: 99%

Are Modic changes prognostic for recovery in a cohort of patients with non-specific low back pain?

et al. 2011

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Background There is evidence for an association between Modic type 1 and pain in patients with low back pain (LBP), but little knowledge about its effect on clinical outcomes. Purpose (1) To assess the prevalence of Modic changes, (2) to determine if Modic changes influence the clinical course of LBP, and (3) to identify prognostic factors for recovery. Study design/setting Prospective clinical cohort study, with a 1-year follow-up. The treatment consisted of brief intervention and instruction in stretching. Patient's sample Two hundred and sixty-nine patients with chronic low back pain. Outcome measures Socio-demographic variables, education, profession, self-reported measures, degenerative changes on MRI. Methods Linear growth model and Cox regression analysis.Results Five percent had a normal MRI, 14 and 50% had Modic 1 and Modic 2 changes. Modic changes were not significant covariates for the clinical course of pain, function or fear avoidance beliefs. Education was a strong prognostic factor for recovery. Conclusions Modic changes did not influence the clinical course of back pain and were not prognostic factors for recovery. Education was strongly associated with recovery.

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“…Recent papers have shown that Modic changes show a high prevalence in patients with degenerative disc disease and are seen in 23% of non-operatively treated sciatica patients [30], with a high rate of increased changes following microdiscectomy [6]. Some authors associate Modic Type 1 changes with low back pain, although conversions to ''more benign'' Type 2 changes seem possible [31,32].…”

Section: Discussionmentioning

confidence: 99%

An injectable nucleus replacement as an adjunct to microdiscectomy: 2 year follow-up in a pilot clinical study

Berlemann¹,

Schwarzenbach²

2009

Eur Spine J

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Literature indicates that loss of disc tissue from herniation and/or surgery can accelerate degeneration of the disc. The associated loss of disc height may correspond with recurrent back and/or leg pain. A novel hydrogel has been developed to replace lost nucleus pulposus and potentially restore normal disc biomechanics following herniation and surgery. A single-center, non-randomized, prospective feasibility study was undertaken to investigate the use of NuCore Ò Injectable Nucleus hydrogel (Spine Wave, Inc., Shelton, CT, USA) as a replacement for nuclear tissue lost to herniation and microdiscectomy. Fourteen patients were enrolled at the authors' hospital as the initial site in a worldwide multicenter pilot study. Subjects who were entered into the study suffered from radicular pain due to single-level herniated nucleus pulposus and were non-respondent to conservative therapy. Following a standard microdiscectomy procedure, the hydrogel material was injected into the nuclear void to replace what tissue had been lost to the herniation and surgery. Leg and back pain, function and disability scores were monitored pre-and post-operatively through 2 years. Neurologic and physical evaluations, blood and serum analyses, and radiographic evaluations of disc height and implant stability were also performed. Results showed significant improvement for leg and back pain, as well as function scores. No complications or device related adverse events were observed. MR controls confirmed stable position of the implants with no reherniations. Radiographic measurements indicated better maintenance of disc height compared to literature data on microdiscectomy alone. The NuCore Ò material appears to protect the disc from early collapse following microdiscectomy; and therefore, may have the potential to slow the degenerative cascade of the spinal segment over time.

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A Three-Year Follow-up of Lumbar Spine Endplate (Modic) Changes

Abstract: Modic changes are common MRI findings in patients with degenerative lumbar disc disease. We found evidence that Modic Type II changes may be less stable than previously assumed.

Cited by 180 publications

References 15 publications

MRI follow-up of subchondral signal abnormalities in a selected group of chronic low back pain patients

MRI follow-up of subchondral signal abnormalities in a selected group of chronic low back pain patients

Are Modic changes prognostic for recovery in a cohort of patients with non-specific low back pain?

An injectable nucleus replacement as an adjunct to microdiscectomy: 2 year follow-up in a pilot clinical study

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