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.     

颈椎Modic改变与轴性疼痛的关系

目的:探讨颈椎病患者椎体终板Modic改变的发病情况及临床价值.方法:回顾分析136例颈椎病患者的颈椎MRI矢状位图像资料,记录椎体终板Modic改变的发生率、类型、各节段分布及各分布节段类型,统计并分析Modic改变与颈部轴性疼痛的关系.结果:136例颈椎病患者中有23例存在Modic改变.发生率为16.9%;男性患者中发生率为17.7%,女性为15%;最常出现Modic改变的节段为C56;Modic Ⅰ型、Ⅱ型和Ⅲ型的发生率分别为4.4%、7.4%、5.1%.存在Modic改变的患者中.轴性疼痛发生率为56.5%.术后缓解率为76.9%;无Modic改变者轴性疼痛的发生率为20.4%,术后缓解率为73.9%,两者轴性疼痛发生率有显著性差异(PO.05).Modic改变Ⅰ、Ⅱ、Ⅲ型患者中轴性疼痛发生率分别为83.3%、60%和28.6%,术后缓解率分别为100%、66.7%和50%;Modic改变I型患者轴性疼痛发生率和术后缓解率均较其他两型为高(PModic改变以Ⅱ型最多,以C5/6节段最为常见.Modic改变患者轴性疼痛发生率较高,其中以Modic Ⅰ型为著.     

TNF-α、IL-6、IL-8在Modic I型改变腰椎终板与椎间盘髓核中的表达及关系研究

目的 探讨腰椎Modic I型改变的腰椎终板与椎间盘髓核中TNF-α、IL-6、IL-8 的相关性。方法 收集30 例因下腰痛入院手术治疗并行腰椎MRI 检查确认为腰椎Modic I型改变患者的术中病灶椎间盘标本,进行免疫组化检测,并观察椎间盘组织病理变化及炎症因子的表达,IL-6、IL-8 相对表达水平以相对表达量△Ct 或（2-△Ct×104）进行分析。结果 Modic I型终板中TNF-α表达水平（9.2±0.7）高于髓核（7.2±0.5）,差异有统计学意义（P＜0.05）;髓核中△Ct IL-6、△Ct IL-8 相对表达量（6.34±1.82、10.62±1.88）高于终板（4.07±1.86、5.92±1.31）,差异均有统计学意义（均P＜0.05）。结论 Modic I型终板中TNF-α、IL-6、IL-8的表达水平明显高于髓核,其引起下腰痛的原因主要为终板的炎症改变。     

Inflammatory pain pattern and pain with lumbar extension associated with Modic 1 changes on MRI: a prospective case–control study of 120 patients

Purpose

To compare, in a case–control study, clinical characteristics of patients with low back pain (LBP) with and without Modic 1 signal changes on MRI.

Methods

Patients with chronic non-specific LBP and a recent (<6 months) MRI were prospectively screened and included in Modic 1 group or control group. Patients in control group were age- and gender-matched with patients with Modic 1 group. Pain characteristics, including night pain and worse pain on waking and morning stiffness, were recorded. The presence of at least one of these three characteristics indicated an inflammatory pain pattern. Patients were evaluated by questionnaires and physical examination (including lumbar range of motion). Data were analyzed by univariate and multivariate analyses.

Results

120 patients were included (60 in each group). The groups did not differ in sedentary work (p = 0.25), morning stiffness for >60 min (p = 0.19), waking at night (p = 0.08), worse pain on waking (p = 0.09), back stiffness (p = 0.12), or pain with flexion (p = 0.87). Modic 1 patients more frequently exhibited an inflammatory pain pattern (p = 0.006), worse pain with lumbar extension (p < 0.005) and responded better to oral steroids (p = 0.004) than did controls. On multivariate analysis, Modic 1 changes were associated with sedentary work [odds ratio 0.22 (95 % confidence interval 0.05–0.93)], pain with lumbar extension [11.2 (3.1–40.4)] and an inflammatory pain pattern [4.5 (1.2–16.9)].

Conclusions

Characteristics of patients with LBP and Modic 1 changes on MRI consist of an inflammatory pain pattern and pain with lumbar extension. Level of evidence 3b.     

The evolution of degenerative marrow (Modic) changes in the cervical spine in neck pain patients

Purpose

To evaluate the natural course of end plate marrow (Modic) changes (MC) in the cervical spine on MRI scans of patients with neck pain. A few longitudinal studies have assessed the development of MC over time in the lumbar spine but only two recent studies evaluated MC in the cervical spine in asymptomatic volunteers and those with whiplash. Thus, this study now reports on the natural course of MC in the cervical spine in symptomatic patients.

Methods

From the cervical MRI scans of 426 neck pain patients (mean age 61.2 years), 64 patients had follow-up MRI studies. The prevalence and types of MC were retrospectively assessed on the follow-up scans and compared to the original MRI findings.

Results

With an average of 2.5 years between the two MRI scans, the prevalence of MC type 1 (MC1) noted at baseline (7.4 % or 19 motion segments) slightly increased (8.2 % or 21 segments) but the prevalence of MC2 (14.5 % or 37 segments) increased considerably (22.3 % or 57 segments). In addition, 14 new MC1 segments and 8 new MC2 segments were noted. Twelve segments with MC1 at baseline converted to MC2 at follow-up. No conversion from MC2 to MC1 or reverting to a normal image was observed.

Conclusions

MC in the cervical spine are a dynamic phenomenon similar to the lumbar spine.     

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。     

Modic Ⅱ型改变对经皮椎间孔镜术疗效的影响

目的 探讨Modic改变对经皮椎间孔镜术疗效的影响。方法 回顾性分析2018年1月－2019年12月在该科行经皮椎间孔镜下腰椎髓核切除术（PELD）的43例腰椎间盘突出症（LDH）患者,根据磁共振成像（MRI）示是否伴有Modic改变将其分为MC组与对照组,分析两组患者术中出血量、手术时间、术前、术后3 d、术后3和6个月的腰痛及腿痛视觉模拟评分（VAS）、日本骨科协会评分（JOA）及Oswestry功能障碍指数（ODI）。结果 两组患者术中出血量、手术时间、术前腰痛VAS评分、术前及术后腿痛VAS评分、术前ODI与JOA评分比较,差异均无统计学意义（P > 0.05）,但术后3 d、术后3和6个月腰痛VAS评分MC组高于对照组（P < 0.01）,术后3和6个月MC组JOA评分均低于对照组（P < 0.01）,术后3和6个月MC组ODI均高于对照组（P < 0.01）,同时与术前相比,两组患者6个月时腰痛VAS评分、腿痛VAS评分、JOA评分及ODI均有改善（P < 0.05）。结论 经皮椎间孔镜术对伴随Modic改变（Ⅱ型）的LDH患者具有良好的疗效,是一种可靠、安全的治疗手段,但Modic改变会影响术后腰痛的缓解,针对此类患者需综合考虑治疗方案。     

ModicⅠ型患者行单纯椎间盘切除术后下腰部疼痛的变化

目的 探讨ModicⅠ型和单纯椎间盘突出症患者椎间盘切除术后下腰部疼痛的变化.方法 40例椎间盘突出症患者,根据有无ModicⅠ型改变将其分为ModicⅠ型组(M组,n=20)和对照组(N组,n=20),均行椎间盘切除术.采用疼痛视觉评分(VAS评分)和Oswestry功能障碍指数(ODI)评估其术前、术后6、12、24个月的疼痛状况.结果 M、N两组间术前、术后6、12、24个月的VAS评分和ODI,除术后12个月N组ODI较M组改善较多外(P<0.05),其余两组差异均无显著性(P>0.05).M组、N组各组内术后6、12、24个月VAS评分及ODI均较术前显著改善(P<0.05).与术前相比,术后24个月VAS评分显著改善,M组从6.8降至2.1(P<0.01),改善率为69%;N组从6.7降至1.6(P<0.01),改善率为76%;与术前相比,术后24个月ODI也明显改善,M组从66%降至15%(P<0.01),N组从64%降至15%(P<0.01),改善率分别为77%和77%.结论 ModicⅠ型和单纯椎间盘突出症患者行椎间盘切除术后,其下腰痛均明显改善且效果相似.单纯椎间盘切除术是治疗ModicⅠ型椎间盘突出症的有效方式.     

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.