Comparison of Modic Changes in the Lumbar and Cervical Spine, in 3167 Patients with and without Spinal Pain

Abstract

Background ContextThere are few comparisons of Modic changes (MCs) in the lumbar and cervical spine.PurposeCompare the prevalence of MCs in the lumbar and cervical spine, and determine how MC prevalence depends on spinal pain, age, disc degeneration, spinal level, and the presence or absence of kyphosis.Study DesignRetrospective clinical survey.Materials and MethodsMagnetic resonance images (MRIs) were compared from five patient groups: 1. 1223 patients with low-back pain/radiculopathy only; 2. 1023 patients with neck pain/radiculopathy only; 3. 497 patients with concurrent low-back and neck symptoms; 4. 304 asymptomatic subjects with lumbar MRIs; and 5. 120 asymptomatic subjects with cervical MRIs.ResultsThe prevalence of MCs was higher in those with spinal pain than in those without, both in the lumbar spine (21.0% vs 10.5%) and cervical spine (8.8% vs 3.3%). Type II MCs were most common and Type III were least common in all groups. The prevalence of lumbar MCs in people with back pain was little affected by the presence of concurrent neck pain, and the same was true for the prevalence of cervical MCs in people with neck pain with or without concurrent back pain. When symptomatic patients were reclassified into two groups (back pain, neck pain), the prevalence of lumbar MCs in people with back pain was greater than that of cervical MCs in people with neck pain. The prevalence of lumbar and cervical MCs increased with age, disc degeneration, (descending) spinal level, and increased kyphosis.ConclusionsThere is a significantly higher prevalence of MCs in patients with back and neck pain. The reported association with increased kyphosis (flat back) is novel.

Anchorage of annulus fibrosus within the vertebral endplate with reference to disc herniation

“…Displaced cartilage endplate fragments probably come from the central portion of the endplate because, in this region, the annulus fiber sub‐bundles do not appear to anchor into the vertebral endplate, so that it is easier to separate the cartilage and bone endplates in this region (Green et al, ; Lama et al, ). This is consistent with the finding that endplate defects (Wang et al, ) and Modic (inflammatory) changes in the endplate (Sheng et al, ) are usually central rather than peripheral. The hyaline cartilage endplates act like biologic “filters,” so focal loss of cartilage will enable proinflammatory mediators to pass from the disc to the vertebral body (Lama et al, ).…”

Quantitative evaluation of normal spinal osseous metabolism with 18F-NaF PET/CT

“…Understanding spinal metabolism in a normal population with respect to potentially influencing factors may lead to an enhanced understanding of the spine. Specifically, age and weight have both been scientifically determined to cause elevated inflammation and degeneration in the spine [13][14][15][16]; moreover, such degeneration has been present in a significant number of those with nonspecific pain [15]. Accordingly, this study aims to describe osseous metabolic activity in the spine as expressed through NaF uptake in a normal male population, and correlate the uptake with age and weight.…”

Characteristics of Modic changes in cervical kyphosis and their association with axial neck pain

“…However, the prevalence distribution of Modic changes is debated, with some authors reporting Modic-1 changes to be most common (16%)25 and others reporting Modic-2 changes to be the most common 9,26,27. In our study, the prevalence of Modic changes for asymptomatic and symptomatic persons with CK was 35.7%.…”