SUMMARY:Two decades following their description, the significance of Modic vertebral endplate and marrow changes remains a matter of debate. These changes are closely related to the normal degenerative process affecting the lumbar spine, and their prevalence increases with age. However, the exact pathogenesis underlying these changes and their relation to segmental instability of the lumbar spine and to low back pain remain unclear. In this paper, we review the literature relevant to this topic and discuss the currently available evidence regarding the pathologic and clinical significance of Modic changes. Degenerative vertebral endplate and subchondral bone marrow changes were first noted on MR imaging by de Roos et al in 1987.1 A formal classification was subsequently provided by 2 based on a study of 474 patients, most of whom had chronic low back pain (LBP). These authors described 2 types of endplate and marrow changes:Type 1 changes (Fig 1) were hypointense on T1-weighted imaging (T1WI) and hyperintense on T2-weighted imaging (T2WI) and were shown to represent bone marrow edema and inflammation.Type 2 changes (Fig 2) were hyperintense on T1WI and isointense or slightly hyperintense on T2WI and were associated with conversion of normal red hemopoietic bone marrow into yellow fatty marrow as a result of marrow ischemia.

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Meningeal melanocytoma is a rare benign CNS tumor derived from the leptomeningeal melanocytes. Although unusual, malignant transformation with leptomeningeal seeding into the brain or spinal cord may occur years after the initial diagnosis. The authors report a unique case of multifocal benign meningeal melanocytoma involving both cerebellopontine angles and the thoracic spinal cord, with associated diffuse leptomeningeal hyperpigmentation. They review the literature relevant to this topic and discuss the radiological and pathological features of this disease as well as its treatment options.

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