Exploratory study for clinical signs of MODIC changes in patients with low-back pain in the Netherlands armed forces

Abstract

Background Magnetic resonance imaging (MRI) is being used extensively in the search for pathoanatomical factors contributing to low back pain (LBP) such as Modic changes (MC). However, it remains unclear whether clinical findings can identify patients with MC. The purpose of this explorative study was to assess the predictive value of six clinical tests and three questionnaires commonly used with patients with low-back pain (LBP) on the presence of Modic changes (MC). Methods A retrospective cohort study was performed using data from Dutch military personnel in the period between April 2013 and July 2016. Questionnaires included the Roland Morris Disability Questionnaire, Numeric Pain Rating Scale, and Pain Self-Efficacy Questionnaire. The clinical examination included (i) range of motion, (ii) presence of pain during flexion and extension, (iii) Prone Instability Test, and (iv) straight leg raise. Backward stepwise regression was used to estimate predictive value for the presence of MC and the type of MC. The exploration of clinical tests was performed by univariable logistic regression models. Results Two hundred eighty-six patients were allocated for the study, and 112 cases with medical records and MRI scans were available; 60 cases with MC and 52 without MC. Age was significantly higher in the MC group. The univariate regression analysis showed a significantly increased odds ratio for pain during flexion movement (2.57 [95% confidence interval (CI): 1.08–6.08]) in the group with MC. Multivariable logistic regression of all clinical symptoms and signs showed no significant association for any of the variables. The diagnostic value of the clinical tests expressed by sensitivity, specificity, positive predictive, and negative predictive values showed, for all the combinations, a low area under the curve (AUC) score, ranging from 0.41 to 0.53. Single-test sensitivity was the highest for pain in flexion: 60% (95% CI: 48.3–70.4). Conclusion No model to predict the presence of MC, based on clinical tests, could be demonstrated. It is therefore not likely that LBP patients with MC are very different from other LBP patients and that they form a specific subgroup. However, the study only explored a limited number of clinical findings and it is possible that larger samples allowing for more variables would conclude differently.

Association of Modic change types and their short tau inversion recovery signals with clinical characteristics- a cross sectional study of chronic low back pain patients in the AIM-study

“…These results suggest that one cannot distinguish patients with type 1 MCs from patients with type 2 MCs only based on clinical symptoms and signs. Our findings are in accordance with a study on Dutch military personnel which reported no differences in various clinical tests between type 1 and 2 MCs [48] and a study which did not report any difference in duration of symptoms between type 1 and type 2 MCs in hospitalized patients [11].…”

Modic changes as seen on MRI are associated with nonspecific chronic lower back pain and disability

“…We do recognise that having published their review protocol in Prospero they had limited freedom to do so. Unfortunately, Herlin et al is often being inappropriately cited as demonstrating no association between LBP and MC without acknowledging its limitations [30][31][32][33][34][35][36][37][38], but others do cite it in a more appropriate nuanced way [23,[39][40][41][42][43][44][45][46][47][48][49].…”

“…Papers citing Herlin et al were identified using Pub-Med [23,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. The literature was searched through PubMed with the keywords "MRI (back pain) association Modic" restricted to the last 5 years and identified 135 articles.…”

Modic Change

“…DWI has been successful in differentiating type 1 MC degeneration from vertebral discitis or osteomyelitis. 43 Similarly, x-rays can be helpful in differentiating MC from other abnormalities such as spondyloarthropathy. 11 Laboratory tests, including erythrocyte sedimentation rate/C-reactive protein, and complete blood count, can exclude alternative diagnoses.…”

“…DWI measures underlying pathology through restricted molecular diffusion of tissue water molecules. DWI has been successful in differentiating type 1 MC degeneration from vertebral discitis or osteomyelitis 43. Similarly, x-rays can be helpful in differentiating MC from other abnormalities such as spondyloarthropathy 11.…”