The location of Modic changes in the lumbar spine: a meta-analysis

Huang, Zhenfeng; Xu, Haichao; Tao, Lei; Li, Qinglong; Wu, Ai-Min; Ni, Wen-Fei

doi:10.1007/s00586-016-4456-x

Cited by 17 publications

(19 citation statements)

References 52 publications

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“…Similar observations were reported in an observational study with a prevalence of no MC in 44.4% (249 individuals) with a mean age of 47.7 years [19]. Furthermore, we found MC most frequently in the lower lumbar region (adjacent to L4/5 and L5/S1) which has also been described elsewhere [8,19]. Therefore, despite the limitations of clinical study conditions, distribution and prevalence of MC are close to what has previously been described in the literature [8,19,20].…”

Section: Discussionsupporting

confidence: 91%

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New insights into the natural course and clinical relevance of Modic changes over 2 years following lumbar limited discectomy: analysis of prospective collected data

et al. 2019

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Purpose Few retrospective studies have addressed Modic changes (MC) following lumbar spine surgery, though it is usually assumed that MC increase in grade and incidence. To test this conventional wisdom, we investigated the natural course of MC following primary lumbar limited discectomy with two-year follow-up. In addition, a possible clinical relevance to those changes was assessed. Methods The data of the control group (278 subjects) of a prospective randomized, controlled trial (RCT) were evaluated retrospectively. Results We did not observe a simple increase in MC with regard to grade. There is variable activity observed in Type 2 (at 12 months) and in Type 1 (at 24 months). Conversion from one grade to another may occur and may be upward or downward. The incidence of MC increased slightly over time, as after surgery a decreasing percentage of the study group remained without MC over two years (1 year: 34% (85/250); 2 years: 30% (72/237)). Radiological parameters (rotation, translation, and spondylolisthesis) had no significant correlation to MC or MC subtypes. Lastly, we found that neither the different MC types nor their changes were correlated with clinical parameters (VAS back, VAS leg, ODI score) preoperatively or during follow-up. Conclusion The pattern of Modic changes following lumbar limited discectomy is complex, not simply increasing. There is variable activity in MC Types 1 and 2 at the different time points of follow-up, and conversion from a higher grader to a lower one or vice versa is possible. Graphical abstractThese slides can be retrieved under Electronic Supplementary Material. Key points 1. Although Modic changes (MC) have widely investigated in conservative treatment, few retrospective studies have addressed Modic changes following lumbar spine surgery. 2. Usually it is assumed, that Modic changes should increase in quality and quantity.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Affiliations

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Section: Discussionsupporting

confidence: 91%

“…In patients without specific pathology or surgery, MC were more common in the lowest two levels, especially L5-S1 [8].…”

Section: Introductionmentioning

confidence: 93%

New insights into the natural course and clinical relevance of Modic changes over 2 years following lumbar limited discectomy: analysis of prospective collected data

et al. 2019

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“…The distribution of MII mainly occurred at the lower two lumbar levels among the different lumbar segments [17]. Also, MCs were more likely to be observed at L5/S1 than L4/5, as reported by a recent systematic review [19]. The lower lumbar levels would be prone to bear the higher mechanical loading than the upper lumbar spine [17].…”

Section: Discussionmentioning

confidence: 99%

Patients with Modic type 2 change have a severe radiographic representation in the process of lumbar degeneration: a retrospective imaging study

Lan

Wang

et al. 2019

J Orthop Surg Res

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Background There are few studies to investigate changes in imaging parameters of Modic changes (MCs). The imaging studies examining the distinctions in the lumbar sagittal parameters between MCs and lumbar disc degeneration (LDD) are still lacking. The purpose of this study was to identify the differences in the lumbar sagittal parameters among patients for LDD with/without Modic type 2 change (MII). Methods A total of 208 patients with lumbar degenerative disease from January 2017 to August 2018 volunteered for this study. Sixty-two patients with MII were used as the MC group. The other 146 patients served as the disc degeneration (DD) group. The DD scores and sagittal parameters were measured on magnetic resonance imaging (MRI) and X-ray by using Surgimap software. Results The prevalence of MII for patients with degenerative lumbar diseases in this study was 29.81%, primarily located at L5/S1. There were significant differences in lumbar lordosis (LL) and sacral slope (SS) between these two groups ( P < 0.05). Similarly, the significant decrease in intervertebral height index (IHI) was found at L3-S1 in the MC group, compared with the DD group ( P < 0.05). However, a significant difference in intervertebral angle (IVA) was observed only at L5/S1 ( P < 0.05). The MC group had the smaller endplate concave angle (ECA) than the DD group from L3 caudal endplate to S1 cranial endplate ( P < 0.05). Conclusions MII has a severe radiographic representation in the process of lumbar degeneration than patients without MII, and the overconcentration of load caused by the smaller LL, SS, and IVA may be a reasonable explanation to answer why MCs are more common at the L5/S1.

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“…Both MT1 and spondylodiscitis most commonly affected L3 to L5, possibly explained by the lower lumbar biomechanical alignment and vascular anatomy, respectively [41]. Therefore, the involvement site does not point toward any specific diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Vertebral Bone Marrow and Endplate Assessment on MR Imaging for the Differentiation of Modic Type 1 Endplate Changes and Infectious Spondylodiscitis

Schwarz‐Nemec

Friedrich

Stihsen

et al. 2020

JCM

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On magnetic resonance (MR) imaging, Modic type 1 (MT1) endplate changes and infectious spondylodiscitis share similar findings. Therefore, this study investigated vertebral bone marrow and endplate changes to enable their differentiation. The lumbar spine MR examinations of 91 adult patients were retrospectively included: 39 with MT1; 19 with early spondylodiscitis without abscess; and 33 with advanced spondylodiscitis with abscess. The assessment included percentage of bone marrow edema on sagittal short tau inversion recovery images, and the signal ratio of edema to unaffected bone and endplate contour (normal; irregular, yet intact; blurred; destructive) on sagittal unenhanced T1-weighted images. Differences were tested for statistical significance by Chi-square test and mixed model analysis of variance. The MR diagnostic accuracy in differentiating MT1 and spondylodiscitis was assessed by cross-tabulation and receiver-operating characteristic analysis. The endplate contours, edema extents, and T1-signal ratios of MT1 (extent, 31.96%; ratio, 0.83) were significantly different (p < 0.001) from early spondylodiscitis (56.42%; 0.60), and advanced spondylodiscitis (91.84%; 0.61). The highest diagnostic accuracy (sensitivity, 94.87%; specificity, 94.23%; accuracy, 94.51%) in identifying MT1 was provided by an irregular, yet intact endplate contour. This may be a useful MR feature for the differentiation between MT1 and spondylodiscitis, particularly in its early stage.

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The location of Modic changes in the lumbar spine: a meta-analysis

Cited by 17 publications

References 52 publications

New insights into the natural course and clinical relevance of Modic changes over 2 years following lumbar limited discectomy: analysis of prospective collected data

New insights into the natural course and clinical relevance of Modic changes over 2 years following lumbar limited discectomy: analysis of prospective collected data

Patients with Modic type 2 change have a severe radiographic representation in the process of lumbar degeneration: a retrospective imaging study

Vertebral Bone Marrow and Endplate Assessment on MR Imaging for the Differentiation of Modic Type 1 Endplate Changes and Infectious Spondylodiscitis

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