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

Romero-Muñoz, L.M.; Barriga-Martín, Andrés; Segura‐Fragoso, Antonio; Martín-González, Candelaria

doi:10.1016/j.recote.2018.04.006

Cited by 8 publications

(11 citation statements)

References 15 publications

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“…The value of short-term studies is limited when trying to assess the long-term consequences of relevant pain generators such as MCs. In accordance with the only other long-term follow-up study, also our study does not support the idea of MCs as a negative predictor of outcome over time 17 .…”

Section: Especially Sincesupporting

confidence: 66%

“…Few studies, however, have examined the long-term PROs in patients with MCs 17 . In contrast to previous studies, the current study did not find any differences in PROs at initial consultation in chronic LBP patients with or without MCs 9,16,22,27 .…”

Section: Discussionmentioning

confidence: 99%

“…Today, high-Tesla MRI are used in most centers which invalidates direct comparisons. The association between MCs and LBP has previously been examined in studies with 1-2 year follow-up and one study with 10-year follow-up 17 . Some studies have reported a higher prevalence of LBP in patients with MCs, particularly MC-1, compared to DD alone, while other studies do not find MCs to be associated with LBP [11][12][13]15,16,26 .…”

Section: None Of the Patients Had Prolonged Courses Of Antibiotics Aimentioning

confidence: 99%

“…Although back pain and disability have been associated with MC in several studies, the results are still conflicting [10][11][12][13][14][15][16] . The currently available studies are predominantly either crosssectional or with short follow-up, and only one looked at long-term influences 17 .…”

Section: Introductionmentioning

confidence: 99%

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Modic Changes Are Not Associated With Long-term Pain and Disability

Udby¹,

Bendix

Ohrt-Nissen³

et al. 2019

Spine

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Study Design: A comparative cohort study with 13-year follow-up. Objective: To assess whether Modic Changes (MCs) are associated with long-term physical disability, back pain and sick leave. Summary of Background Data: Previous studies have shown a conflicting association of low back pain (LBP) with MCs and disc degeneration. The long-term prognosis of patients with MCs is unclear. Methods: In 2004-2005, patients aged 18-60 with daily LBP were enrolled in an RCT study and lumbar MRI was performed. Patients completed numeric rating scales (NRS, 0-10) for LBP and leg pain (LP), Roland-Morris Disability Questionnaire (RMDQ), LBP Rating Scale for activity limitations (RS, 0-30), Inflammatory pain pattern (IPP) and sick leave days due to LBP at baseline and 13-years after the MRI. Patients were stratified based on the presence (+MC) or absence (-MC) of MCs on the MRI. Results: Of 204 cases with baseline MRI, 170 (83%) were available for follow-up; 67 (39%) with MCs and 103 (61%) without MCs. Demographics, smoking status, BMI, use of antibiotics, LBP, LP and IPP scores at baseline and at 13-year follow-up were similar between the two groups. Also, baseline RMDQ was similar between the +MC and-MC groups. At 13 years, the RMDQ score was statistically significant better in the +MC group (7.4) compared to the-MC group (9.6, p=0.024). Sick leave days due to LBP were similar at baseline but less in the +MC group (9.0) compared to the-MC group (22.9 days, p=0.003) at 13 years. Conclusion: MCs were not found to be negatively associated with long-term pain, disability or sick leave. Rather, the study found that LBP patients with MCs had significantly less disability and sick-leave at long-term follow-up. We encourage further studies to elucidate these findings.

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Section: Especially Sincesupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: None Of the Patients Had Prolonged Courses Of Antibiotics Aimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Modic Changes Are Not Associated With Long-term Pain and Disability

Udby¹,

Bendix

Ohrt-Nissen³

et al. 2019

Spine

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show abstract

“…3,20,21 Few studies, however, have examined the long-term association between such findings and spine-related disability. 22 The aim of the study was to assess whether baseline MRI findings indicating degeneration are associated with long-term disability in patients with LBP.…”

Section: Introductionmentioning

confidence: 99%

The Association of MRI Findings and Long-Term Disability in Patients With Chronic Low Back Pain

Udby

Ohrt-Nissen

Bendix

et al. 2020

Global Spine Journal

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Study Design: Longitudinal cohort study with 13-year follow-up. Objective: To assess whether long-term disability is associated with baseline degenerative magnetic resonance imaging (MRI) findings in patients with low back pain (LBP). Methods: In 2004-2005, patients aged 18 to 60 years with chronic LBP were enrolled in a randomized controlled trial and lumbar MRI was performed. Patients completed the Roland-Morris Disability Questionnaire (RMDQ) and the LBP Rating Scale, at baseline and 13 years after the MRI. Multivariate regression analysis was performed with 13-year RMDQ as the dependent variable and baseline disc degeneration (DD, Pfirrmann grade), Modic changes (MC), facet joint degeneration (FJD, Fujiwara grade) smoking status, body mass index, and self-reported weekly physical activity at leisure as independent variables. Results: Of 204 patients with baseline MRI, 170 (83%) were available for follow-up. Of these, 88 had Pfirrmann grade >III (52%), 67 had MC (39%) and 139 had Fujiwara grade >2 (82%) on at least 1 lumbar level. Only MC (β = −0.15, P = .031) and weekly physical activity at leisure (β = −0.51, P < .001) were significantly, negatively, associated with 13-year RMDQ-score ( R 2 = 0.31). Conclusion: DD and FJD were not associated with long-term disability. Baseline MC and weekly physical activity at leisure were statistically significantly associated with less long-term disability.

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A definition and clinical grading of Modic changes

Udby

Samartzis

Carreon

et al. 2021

Journal Orthopaedic Research

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To provide an up-to-date description of knowledge and pitfalls related to the classification, definition and grading of Modic changes (MC) visualized on magnetic resonance imaging (MRI). State-of-the-art review of current knowledge regarding the definition and grading of MC on MRI. MC on MRI have been reported to be associated with low back pain and disability. However, previous studies have shown heterogeneous results in regards to the impact of MC and its clinical relevance in patients with back pain. MC is a term used with considerable variation in the literature. No strict definition has been provided previously, this has contributed to varying diagnostic inclusion criteria, heterogeneous study populations, and discrepancy in results. A definition of MC and a proposal for grading is provided in this state-of-the-art review. MC are important, clinically relevant findings. However, issues with the nomenclature, definition and grading of these changes need to be addressed. Our current review highlights relevant issues related to MC, and provides a definition and grading score for the term MC that includes the Modic type and the extent of vertebral body involvement. Future studies should seek to validate the MC grading score in clinically relevant populations.

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

Cited by 8 publications

References 15 publications

Modic Changes Are Not Associated With Long-term Pain and Disability

Modic Changes Are Not Associated With Long-term Pain and Disability

The Association of MRI Findings and Long-Term Disability in Patients With Chronic Low Back Pain

A definition and clinical grading of Modic changes

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