Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain

Abstract

The prevalence of ''vertebral endplate signal changes'' (VESC) and its association with low back pain (LBP) varies greatly between studies. This wide range in reported prevalence rates and associations with LBP could be explained by differences in the definitions of VESC, LBP, or study sample. The objectives of this systematic critical review were to investigate the current literature in relation to the prevalence of VESC (including Modic changes) and the association with non-specific low back pain (LBP). The MEDLINE, EMBASE, and SveMED databases were searched for the period 1984 to November 2007. Included were the articles that reported the prevalence of VESC in non-LBP, general, working, and clinical populations. Included were also articles that investigated the association between VESC and LBP. Articles on specific LBP conditions were excluded. A checklist including items related to the research questions and overall quality of the articles was used for data collection and quality assessment. The reported prevalence rates were studied in relation to mean age, gender, study sample, year of publication, country of study, and quality score. To estimate the association between VESC and LBP, 2 9 2 tables were created to calculate the exact odds ratio (OR) with 95% confidence intervals. Eighty-two study samples from 77 original articles were identified and included in the analysis. The median of the reported prevalence rates for any type of VESC was 43% in patients with non-specific LBP and/or sciatica and 6% in non-clinical populations. The prevalence was positively associated with age and was negatively associated with the overall quality of the studies. A positive association between VESC and non-specific LBP was found in seven of ten studies from the general, working, and clinical populations with ORs from 2.0 to 19.9. This systematic review shows that VESC is a common MRI-finding in patients with non-specific LBP and is associated with pain. However, it should be noted that VESC may be present in individuals without LBP.

Are Modic changes prognostic for recovery in a cohort of patients with non-specific low back pain?

“…Although, there is general agreement that MT1 changes are strongly associated with pain [4], we did not find any association to the clinical course or to patients' selfreported recovery rate. Modic-associated proinflammatory biochemical mediators have been suggested to be a major origin of pain [6].…”

“…Lower education is often associated to low-decision authority and heavy physical work, which are well-known prognostic factors for poor recovery [18]. The prevalence of MT1 changes in our study was 14%, which is comparable to some studies [19], while in other studies the prevalence varied from 43 to 59% [4]; however, these studies included patients who had undergone discography, which is known to accelerate Modic changes [11].…”

Signal intensity changes of the posterior elements of the lumbar spine in symptomatic adults

“…Modic type 1 change, a well-known radiological finding around the vertebral endplates and subchondral bone marrow that neighbor degenerated intervertebral discs of the lumbar spine, suggests inflammation and bone marrow edema related to low back pain [1][2][3] . The clinical significance of similar SCs of the posterior elements has not yet been elucidated, although a few reports in the literature describe the occurrence 4,5) .…”

Modic type I changes and recovery of back pain after lumbar microdiscectomy

“…MC, regardless of type, have been shown to coincide with with degenerative changes of intervertebral disc and chronic low back pain (CLBP) [2][3][4][5]. MC I refers to an edema-like signal intensity (hypointense T1 and hyperintense T2 signal), MC II refers to fat-like signal intensity (hyperintense T1 and isointense or slightly hyperintense T2), and MC III refers to a sclerosis-like signal intensity (hypointense T1 and T2.…”