下腰痛患者Modic改变的临床分布及其分型的相关因素

目的 探讨下腰痛患者Modic改变的临床分布及其分型的相关因素。方法 收集103例下腰痛患者的性别、年龄、受累节段、相关节段的椎间盘退变和突出、腰椎曲度和终板凹角等数据,采用单因素分析和logistic回归分析Modic改变分型的相关因素。结果Modic改变的患者中Ⅰ型16例(15. 5%),Ⅱ型83例(80. 6%),Ⅲ型4例(3. 9%)。共127个节段存在Modic改变:L1～2节段3个,L2～3节段8个,L3～4节段13个,L4～5节段38个,L5～S1节段65个。因Ⅲ型Modic改变的病例过少,各相关因素的分析中仅对Ⅰ型和Ⅱ型进行统计研究。单因素分析表明年龄、椎间盘退变和L4～5前凸角与Modic改变分型有关,logistic回归分析表明仅年龄与Modic改变分型有关。结论 在下腰痛患者中Modic改变Ⅱ型最为常见,其次是Ⅰ型,Ⅲ型不常见;Modic改变主要发生在L4～5和L5～S1节段;年龄是Modic改变分型的影响因素。     

腰椎终板Modic改变与腰椎间盘突出的相关性研究

[目的]探讨腰椎终板Modic改变与腰椎间盘突出的相关性及其意义.[方法]对628例患者(年龄14～85岁,平均50岁;男326例,女302例)腰椎MRI上L3、4～L5S1节段的Modic改变和腰椎间盘突出程度进行评估,统计两者的相关性.将单节段中、重度腰椎间盘突出者分为A组(仅该节段有Modic改变)和B组(任一节段均无Modic改变).统计两组下腰痛的发生率并采用疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数评分(oswestry disability index,ODI)来评估腰痛程度.[结果]在1844个腰椎间盘中,椎间盘无突出组、轻度突出组、中度突出组和重度突出组Modic改变的发生率分别为6.83％、23.66％、42.72％和50.79％,差异有统计学意义(P＜0.01),Spearman相关检验表明Modic改变和腰椎间盘突出程度呈正相关(r=0.344,P＜0.01).A、B组下腰痛的发生率分别为59.32％和37.97％,差异有统计学意义(P＜0.01),但腰痛VAS评分和ODI评分差异无统计学意义(P＞0.05).[结论]腰椎终板Modic改变的发生与腰椎间盘突出程度呈正相关,当腰椎间盘突出合并Modic 改变特别是Ⅰ型改变时,下腰痛的发生率增加.     

腰痛患者下腰椎MRI上Modic改变与高信号区的发生情况及意义

目的:探讨腰痛患者下腰椎MRI上Modic改变与腰椎间盘局限性高信号区(high-intensity zone,HIZ)的发生情况及意义。方法:对511例腰痛患者(男263例,女248例;年龄20~70岁,平均48岁)腰椎MRI上L4/5和L5/S1节段的Modic改变和HIZ进行评估,统计两者及两者共存于同一节段的发生率。将有Modic改变和/或HIZ的椎间盘分为Modic组、Modic-HIZ组、HIZ组,比较3组的年龄、椎间盘高度、椎间盘退变程度、腰痛VAS和ODI评分。结果:511例患者中,190例(37.18%)209个节段有Modic改变,127例(24.85%)142个椎间盘有HIZ,18例(3.52%)18个节段出现Modic改变和HIZ共存的现象。HIZ组、Modic-HIZ组和Modic组分别为89例(124个节段)、18例(18个节段)、152例(191个节段),患者平均年龄分别为46.0±11.0岁、49.2±9.2岁和53.5±10.6岁,仅HIZ组和Modic组差异有统计学意义(P<0.05);椎间盘平均高度分别为9.93±2.46mm、8.73±2.45mm和7.57±2.21mm,组间两两比较差异有统计学意义(P<0.05);3组椎间盘退变分级均≥Ⅲ级,其中Ⅳ级+Ⅴ级退变率分别为48.39%、72.22%和75.92%,仅HIZ组与Modic组、Modic-HIZ组差异有统计学意义(P<0.05);腰痛VAS分别为8.39±0.32分、8.45±0.30分、8.61±0.54分,ODI评分分别为38.22±4.23分、38.45±4.16分、39.18±3.53分,3组间无统计学差异(P>0.05)。结论:腰痛患者下腰椎Modic改变和HIZ的发生率较高,但两者共存于同一节段的发生率低,当两者共存于同一节段时腰痛并不会明显加重。     

腰椎Modic改变的MRI定量与下腰痛相关性研究

目的：通过测定MRI T2正中矢状位像上腰椎终板Modic面积改变率分析Modic面积改变率大小与下腰痛程度的相关性。方法：2011年12月至2012年6月,对因下腰痛手术的70例患者进行疼痛和功能评分（JOA、VAS）和MRI检查,男39例,女31例;年龄29～72岁,平均（51.00±11.89）岁。70例中54例有腰椎终板Modic改变,将54例患者按Modic分型标准分为4型：Modic I型15例,ModicⅡ型21例,Modic Ⅲ型11例,Modic混和型7例（由于Modic混合型例数太少未纳入研究排除）.在MRI T2正中矢状位上测量各分型Modic改变面积及对应椎体的面积,两者面积比较得出Modic改变率,对于多节段Modic改变的求比率之和,观察JOA、VAS评分与Modic改变率之间的相关性。结果：ModicⅠ型改变率和JOA评分的相关系数r=-0.308,P=0.048<0.05,两者具有负相关性;与VAS评分的相关系数r=0.428,P=0.021<0.05,两者具有正相关性。ModicⅡ型改变率和JOA评分的相关系数r=-0.375,P=0.043<0.05,两者有负相关性;与VAS评分的相关系数r=0.352,P=0.041<0.05,两者具有正相关性。Modic Ⅲ型面积改变率与下腰痛程度无明显相关性（P>0.05）.结论：下腰痛患者中ModicⅠ、Ⅱ型面积改变率分别与下腰痛的疼痛程度有密切关系,ModicⅢ型面积改变率与下腰痛程度无明显相关性。     

腰椎Modic改变与终板缺损体积和形态的联系及二者与腰痛相关性的研究

【摘要】 目的：分析腰椎Modic改变的体积与终板缺损的体积、形态的相关性,探究相关终板病变与腰痛症状的联系。方法：回顾性分析2020年10月~2023年10月于苏州大学附属第二医院行腰椎MRI检查有终板缺损的401例患者的临床及影像资料,根据是否合并Modic改变分为两组：Modic改变组（204例）和无Modic改变组（197例）,测量并计算两组患者终板缺损的体积分数并评估两组患者腰椎终板缺损的形态,分为典型形态组（凹陷形、三角形、圆形）和非典型形态组（矩形、不规则形）。测量Modic改变204例患者Modic改变的长、宽、高,并计算体积分数。分析Modic改变的体积分数与终板缺损的体积分数、形态的相关性。根据所有患者椎间盘退变等级分组,对每组患者分别进行Modic改变的体积分数与终板缺损的体积分数、形态分组的相关性分析。随访患者腰痛情况,对不同终板缺损形态与是否合并Modic改变患者腰痛患病率进行比较。结果：典型形态组共369个椎体,152个椎体合并Modic改变;非典型形态组共191个椎体,149个椎体合并Modic改变。Modic改变组的腰椎终板缺损体积分数为0.017±0.014,无Modic改变组的腰椎终板缺损体积分数为0.008±0.007。非典型形态组终板缺损患者的Modic改变体积分数0.20±0.13,典型形态组终板缺损患者Modic改变体积分数0.11±0.10,差异有统计学意义（P<0.001）。腰椎Modic改变的体积分数与终板缺损体积分数的变化呈线性正相关（P<0.001）。椎间盘轻度与中度退变的患者中,Modic改变的体积与终板缺损的体积与形态有着相关性（P<0.05）;在椎间盘重度退变的患者中,Modic改变的体积与终板缺损的体积有着相关性（P<0.001）,Modic改变的体积分数与终板缺损的形态之间未见相关性（P＞0.05）。共随访65例患者腰痛情况,有30例患者出现腰痛症状（Modic改变组24例,无Modic改变组6例）,终板缺损合并Modic改变的患者腰痛患病率高于单纯终板缺损患者（P<0.05）,不同终板缺损形态患者腰痛患病率间无明显差异（P>0.05）。结论：腰椎Modic改变的体积分数与终板缺损的体积分数呈现显著的线性正相关性;椎间盘轻度与中度退变的患者中,非典型组形态的终板缺损患者的Modic改变体积分数普遍大于典型形态组;合并Modic改变患者中腰痛的比例更高。     

颈椎Modic改变与颈椎退行性疾病的关系

目的探讨颈椎Modic改变与颈椎退行性疾病之间的关系。方法对78例Modic改变患者的颈椎退行性疾病进行统计,分析其与Modic改变之间的关系。结果 78例患者中30例(38.5%)诊断为轻度颈椎退行性疾病,26例(33.3%)诊断为中度颈椎退行性疾病,22例(28.2%)诊断为重度颈椎退行性疾病。结论颈椎Modic改变好发于老年患者,以Ⅱ型改变居多,多发生于C5~6、C6~7节段,与颈椎退行性疾病的程度无明显关系。     

绝经后腰痛女性骨密度及骨转换标志物与腰椎Modic改变的相关性研究

目的探讨绝经后慢性腰痛女性骨密度(BMD)及骨转换标志物(BTMs)与腰椎Modic改变的相关性。方法回顾性分析2017年1月至2019年12月因慢性腰痛伴或不伴下肢放射痛在本院就诊的200例绝经后女性患者,采用双能X线测定腰椎BMD;采用罗氏化学发光法测定空腹静脉血Ⅰ型原胶原N末端前肽(PINP)、Ⅰ型胶原C末端肽特殊序列(β-CTX)水平;通过MRI检查患者腰椎Modic改变情况;采用二分类Logistic回归分析患者BTMs与腰椎BMD和腰椎Modic改变的相关性。结果 200例绝经后慢性腰痛女性腰椎Modic改变发生率为51.5%,Modic改变患者腰椎BMD低于无Modic改变患者,二者差异具有统计学意义,而PINP和β-CTX水平高于无Modic改变患者,二者差异具有统计学意义(P0.05)。β-CTX和PINP与Modic改变呈正相关,关联具有统计学意义(P0.05),而腰椎BMD与Modic改变呈负相关,关联具有统计学意义(P0.05)。结论绝经后慢性腰痛女性腰椎BMD及BTMs与腰椎Modic改变有相关性;随着BTMs升高或者BMD降低,腰椎Modic改变的发生率升高,提示临床上应早期监测绝经后慢性腰痛女性BTMs和腰椎BMD的变化,早期给予抗骨质疏松治疗,为治疗绝经后女性腰椎Modic改变引起的背痛患者提供了新的思路。     

颈椎Modic改变研究现状

Modic改变是指椎体终板及终板下骨质在MRI上的信号异常改变。颈椎Modic改变以Ⅱ型为主,节段以C_(5、6)为主。其发生与高龄和椎间盘退变相关性较强。颈椎Modic改变是否会产生相关临床症状仍有争议。手术治疗颈椎病伴颈椎Modic可获得良好疗效,颈椎Modic改变和手术疗效互相影响。     

腰椎疾病中Modic改变的相关研究进展

Modic改变(MCs)作为腰椎脊柱退变的影像特征受到越来越多的关注,随着研究的不断深入,发现不同腰椎疾病的患者多存在MCs,MCs与脊柱腰椎许多疾病逐渐联系起来.但目前的研究大多以终板MCs后引起的症状为主要方向.该文就椎体MCs与腰椎疾病的相关研究进展进行综述.     

HIZ与Modic改变及腰椎间盘退变的相关性研究

目的探讨下腰痛患者腰椎MRI上HIZ与Modic改变及腰椎间盘退变间的相关性特点。方法回顾性分析我院2013-01-2014-12间就诊的411例患者,根据患者腰椎MRI观察腰椎间盘退变、Modic改变及HIZ三者之间的相关关系。结果腰椎间盘退变与Modic改变在各节段均存在正相关,但各节段之间的关联性以邻近节段显著;L_(4-5)、L_5-S_1两个节段的腰椎退变程度与HIZ的出现存在正相关;腰椎间盘节段的Modic改变与HIZ之间并无显著相关性。结论 Modic改变及HIZ的出现均提示腰椎间盘的退行性变,而且Modic改变的出现提示了腰椎临近节段的退变,但两者均为独立性因素。     

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

Purpose

To investigate whether the presence of Modic changes type I (MC I) found on preoperative MRI scans represent a risk factor for persistent back pain 12 months after surgery amongst patients operated for lumbar disc herniation.

Methods

Cohort study of 178 consecutive patients operated with lumbar microdiscectomy. Preoperative MRI scans were evaluated by two independent neuroradiologists. Primary outcome measure was the visual analogue scale (VAS) for back pain. Secondary outcome measures were; VAS for leg pain, physical function (Oswestry Disability Index), and health-related quality of life (EQ-5D), self-reported benefit of the operation and employment status. The presence of MC I was used as exposition variable and adjusted for other risk factors in multivariate analyses.

Results

The Modic classification showed a high inter-observer reproducibility. Patients with MC I had less improvement of back pain 12 months after surgery, compared to those who had no or other types of MC, but this negative association no longer showed statistical significance when adjusted for smoking, which remained the only independent risk factor for persistent back pain.

Conclusions

Patients with preoperative MC I can expect less but still significant improvement of back pain 1 year after microdiscectomy, but not if they smoke cigarettes.     

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

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.     

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

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 × 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.     

Modic changes following lumbar disc herniation

Only a small proportion (20%) of patients with LBP can be diagnosed based on a patho-anatomical entity. Therefore, the identification of relevant subgroups, preferably on a patoanatomical basis, is strongly needed. Modic changes have been described by several authors as being closely linked with LBP. The aims of this study were to describe the prevalence of Modic changes, their development as well as their association to LBP, previous disc contour, and surgery in patients with previous severe sciatica. This is a longitudinal cohort study where the patients were recruited from an RCT comparing two active conservative treatments, the 181 patients, who at baseline had radicular pain in or below the knee; all underwent a physical examination and MRI. MRI’s, pain history and physical examination of 166 patients were obtained at follow-up 14 months later. The prevalence of Modic changes type 1 increased from 9% at baseline to 29% at follow-up. At that time, a strong association between Modic changes and non-specific LBP was noted. Apparently, Modic changes type 1 was more strongly associated with non-specific lumbar pain than Modic changes type 2. The development of new Modic changes was closely related to the level of a previous disc herniation. A lumbar disc herniation is a strong risk factor for developing Modic changes (especially type 1) during the following year. Furthermore, Modic changes are strongly associated with LBP.