Modic I changes size increase from supine to standing MRI correlates with increase in pain intensity in standing position: uncovering the “biomechanical stress” and “active discopathy” theories in low back pain

Abstract

Purpose To evaluate the relationship between degenerative disc, endplate Modic changes (MC) type I, and pain during upright weight-bearing MRI scan of the lumbar spine in a cohort of patients with non-specific low back pain. Materials and methodsWe evaluated 38 patients with non-specific low back pain and MRI evidence of Modic I vertebral changes. The patients were evaluated in a standard and upright weight-bearing position using a dedicated MR unit. The extent of endplate MC type I, intervertebral disc height at the involved level, and degree of degeneration in the same intervertebral disc were compared. Pain was assessed through the VAS questionnaire. Results In the upright position, the area of Modic I changes increased in 26 patients (68.4%, p ≤ 0.001) compared to the supine position. In the upright position, reduction in the disc height was found in 35 patients (92.1%). Correlation analysis showed moderate negative correlation (ρ = − 0.45) between intervertebral disc height and increase in the area of Modic I changes, and weak positive correlation (ρ = 0.12) between Pfirrmann grade and increase in the area of Modic I changes. At clinical evaluation, 30 patients (78.9%) reported worsening of low back pain standing in the upright position. Increase in VAS values on the upright position correlated significantly (ρ = 0.34) with an increase in the area of Modic I changes. Conclusions Our results showed the modifications of Modic I changes under loading, with MRI evidence of increased MC area extent in the upright position and correlation between Modic changes extension increase and increase in pain in the standing position. Weight-bearing MRI scans represent a valuable complement to standard sequences since they provide the radiologist with additional diagnostic information about low back pain. Graphical abstractThese slides can be retrieved from Electronic Supplementary Material. Key pointsSplendiani A, Bruno F, Marsecano C, Arrigoni F, di Cesare E, Barile A, Masciocchi C (2019) Modic I changes size increase from supine to standing MRI correlates with increase of pain intensity in standing position: uncovering the "biomechanical stress" and "active discopathy" theories in low back pain. Eur Spine J;

Short tau inversion recovery MRI of Modic changes: a reliability study

“…STIR series are sensitive to edema and are highly relevant for evaluation of MCs. The association between MCs and pain is inconsistent (13)(14)(15)(16), but edema type MCs might be symptomatic (17)(18)(19). Mechanical, autoimmune, and infectious explanations for MCs have been proposed (20), and various treatments have been and are being tested (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34).…”

Oedema on STIR modified the effect of amoxicillin as treatment for chronic low back pain with Modic changes—subgroup analysis of a randomized trial

“…MCs were related to low back pain (LBP) in some studies but not in others [7][8][9]. The evidence for an association between MCs and LBP is stronger for type 1 than for type 2 or 3 MCs [10][11][12][13][14][15]. Proposed explanations for MCs include endplate damage, autoimmunity, and occult discitis [5].…”

Modic changes in the lumbar spine: histology, risk factors, clinical presentation and treatment

“…There is a negative correlation revealed between the IVD height and MCs1 surface enlargement and a weak positive correlation revealed between the disc degeneration (by Pfirrmann) and MCs1 surface enlargement [16].…”