End plate marrow changes in the asymptomatic lumbosacral spine: frequency, distribution and correlation with age and degenerative changes

Chung, Christine B.; Berg, Bruno C. Vande; Tavernier, T.; Cotten, Anne; Laredo, Jean‐Denis; Vallée, C.; Malghem, Jacques

doi:10.1007/s00256-004-0780-z

Cited by 98 publications

(84 citation statements)

References 16 publications

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“…In our study, the carefully selected group of LBP patients with M1 consisted of 24 (2.4%) patients of the 1,015 base population. In previous studies, the reported prevalence of subchondral signal abnormalities varies, that of hypointensities between 4% and 16% [2,6,11,13,17,22]. This is obviously due to varying criteria for abnormalities and selection of subjects.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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

et al. 2008

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“…Further large-scale studies are required to clarify this issue given the reports of spinal pathoanatomic findings among asymptomatic individuals [8,9,30], including Modic changes [36]. Finally, this study was cross-sectional in design and therefore we neither infer causation between IVD pathology and Modic changes nor comment with certainty regarding the natural history of spinal pathoanatomy across the life course or the pathologic sequence of Modic changes.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of MRI-defined spinal pathoanatomies and their association with Modic changes in individuals seeking care for low back pain

et al. 2011

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Modic changes are of increasing interest, however their age and gender prevalence are not well described. To date, the associations between Modic changes and other common vertebral pathologies have only been described in small samples (n \ 100). Our aim was, in a large dataset of people with low back pain, to (1) describe the prevalence of a range of spinal pathoanatomies, and (2) examine the association between Modic changes and stages of intervertebral disc (IVD) pathology. Common pathologies were coded from the lumbar spine MRIs from 4,233 consecutive people imaged while attending a publicly-funded secondary care outpatient facility in Denmark. Prevalence data were calculated by pathology and by vertebral level. Prevalence was also calculated by age and gender categories for Modic changes. The association between stages of IVD pathology (degeneration, bulge, herniation) and Modic changes at L4/5 and L5/S1 was expressed using prevalence ratios (PR) and 95% confidence intervals. The prevalence of Modic changes and IVD pathology were greater in L4/ 5 and L5/S1, compared with the upper lumbar spine. There was no significant gender difference in prevalence of Modic changes (p = 0.11). The prevalence of IVD disc pathology occurring concurrently with Modic changes ranged from 11.5 to 17.5% (Type 1), 8.5 to 12.7% (Type 2) and 17.1 to 25.6% (Type 1 and/or 2) while the prevalence occurring in the absence of Modic changes ranged from 0.5 to 6.3% (Type 1), 0.3 to 4.9 (Type 2), 0.8 to 9.7% (Type 1 and/or 2). The associated PR for IVD pathology occurring concurrently with Modic changes ranged from 1.8 to 29.2 (p \ 0.05). The highest PR (29.2) was between degeneration and Modic changes, indicating that it is rare for Modic changes to occur without disc degeneration. Spinal pathoanatomy was common in this population, particularly IVD pathologies, and a consistent trend of a relatively greater prevalence in the lower lumbar spine was identified. Modic changes were more likely to be present among individuals with IVD pathology than without, which may implicate mechanical factors as being one aetiological pathway for Modic changes, although other hypotheses may equally explain this association.

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“…In asymptomatic people, MCs have been reported as being mainly small and located in the anterior parts of the vertebrae at the upper lumbar levels [7]; whereas in people with LBP, MCs are larger, located at the lower lumbar levels [19] and more likely to involve more than just the anterior part of the endplate [9]. Although MCs are known to change from one type to another [26], only 23 % of the persons with MCs in a nonclinical population did not have MCs 4 years later [9].…”

Section: Introductionmentioning

confidence: 99%

Is the development of Modic changes associated with clinical symptoms? A 14-month cohort study with MRI

et al. 2012

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Purpose Modic changes (MCs) have been suggested to be a diagnostic subgroup of low back pain (LBP). However, the clinical implications of MCs remain unclear. For this reason, the aims of this study were to investigate how MCs developed over a 14-month period and if changes in the size and/or the pathological type of MCs were associated with changes in clinical symptoms in a cohort of patients with persistent LBP and MCs. Methods Information on LBP intensity and detailed information from MRI on the presence, type and size of MCs was collected at baseline and follow-up. Changes in type (Type I, II, III and mixed types) and size of MCs were quantified at both time points according to a standardised evaluation protocol. The associations between change in type, change in size and change in LBP intensity were calculated using odds ratios (ORs). Results Approximately 40 % of the MCs followed the expected developmental path from Type I (here Type I or I/II) to Type II (here Type II or II/III) or Type I to Type I/II. In general, the bigger the size of the MC at baseline, the more likely it was that it remained unchanged in size after 14 months. Patients who had MC Type I at both baseline and 14-month follow-up were less likely to experience an improvement in their LBP intensity as compared to patients who did not have Type I changes at both time points (OR 7.2, CI 1.3-37). There was no association between change in size of MCs Type I and change in LBP intensity. Conclusions The presence of MCs Type I at both baseline and follow-up is associated with a poor outcome in patients with persistent LBP and MCs.

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End plate marrow changes in the asymptomatic lumbosacral spine: frequency, distribution and correlation with age and degenerative changes

Abstract: End plate marrow signal intensity changes are present in the lumbar spine of some asymptomatic subjects with a characteristic location along the spine and in vertebral end plates.

Cited by 98 publications

References 16 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

The prevalence of MRI-defined spinal pathoanatomies and their association with Modic changes in individuals seeking care for low back pain

Is the development of Modic changes associated with clinical symptoms? A 14-month cohort study with MRI

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