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

Bailly, Franck; Maigne, Jean-Yves; Genevay, Stéphane; Marty, Marc; Gandjbakhch, Frédérique; Rozenberg, Sylvie; Foltz, Violaine

doi:10.1007/s00586-013-3036-6

Cited by 49 publications

(38 citation statements)

References 23 publications

(29 reference statements)

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“…At present, no work has previously studied the dynamic behaviour of Modic changes. In particular, Modic type I changes have been pointed out as a potential marker of LBP [15]. Modic…”

Section: Introductionmentioning

confidence: 99%

Low back pain patients and controls display functional differences in endplates and vertebrae measured with T2-mapping

2018

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Purpose The aim was to (1) verify our previous finding that endplates (EPs) display load-induced T2-changes, (2) investigate whether vertebrae display load-induced T2-changes and (3) investigate whether EPs and vertebrae in LBP patients and controls display T2-differences during conventional unloaded MRI and axial loaded MRI (alMRI). Methods Twenty-seven patients (mean 39 years) and 12 (mean 38 years) controls were examined with T2-mapping on a 1.5 T scanner during conventional unloaded MRI and subsequently during alMRI (Dynawell ® loading device), separated by approximately 20 min. For determination of EP and vertebral T2-values, volumetric regions of interest were manually segmented. Each vertebra was then divided into half to obtain superior and inferior units. The presence of EP changes (visual inhomogeneity in the EP zone), Schmorl's nodules and Modic changes were registered. Results For conventional unloaded MRI, the T2-values in the superior and inferior vertebral units and the EPs were significantly higher in the patients compared with controls (p < 0.03, p < 0.006) even when adjusted for the presence of Modic changes, Schmorl's nodules and EP signal changes. alMRI induced significant changes in the superior EPs of the patients (p < 0.001). Additionally, the T2-value differed significantly between the superior and inferior EP, as well as between the superior and inferior vertebra with higher values in the inferior units (p < 0.001). Conclusion This study demonstrated significantly higher EP and vertebral T2-values in LBP patients in comparison with controls. In addition, alMRI induced significant T2-changes in the superior EPs for patients but not for controls. Importantly, the T2-differences between the groups may indicate that EPs and vertebrae in LBP patients have altered biodynamical characteristics compared to controls and the higher T2-values measured in patients may represent early inflammation or impaired nutritional transport.Graphical abstract These slides can be retrieved from electronic supplementary material.

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“…At present, no work has previously studied the dynamic behaviour of Modic changes. In particular, Modic type I changes have been pointed out as a potential marker of LBP [15]. Modic…”

Section: Introductionmentioning

confidence: 99%

Low back pain patients and controls display functional differences in endplates and vertebrae measured with T2-mapping

2018

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“…Modic 1 signal changes detected on magnetic resonance imaging (MRI) encompass clinical [1–3], radiological [4, 5] and biological [3] features, which allows for defining a specific subgroup of patients with chronic low back pain (cLBP) [6, 7]. Elementary MRI and histopathological alterations involving intervertebral disc (IVD) and vertebral endplate subchondral bone (VESB) associated with Modic 1 changes, were first described and classified by Modic et al , in the late 1980s, in 474 patients [4, 5].…”

Section: Introductionmentioning

confidence: 99%

Intervertebral disc and vertebral endplate subchondral changes associated with Modic 1 changes of the lumbar spine: a cross-sectional study

Nguyen

Jousse

Poiraudeau

et al. 2017

BMC Musculoskelet Disord

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BackgroundModic 1 changes are usually associated with degenerative disc disease (DDD). We aimed to compare Modic 1 changes with advanced degenerative disc disease (>50%-intervertebral space narrowing [IVSN]) to Modic 1 changes with less advanced lumbar degenerative disc disease (≤50%-IVSN).MethodsWe conducted a cross-sectional study. The computerized MRI database from a French tertiary care hospital was searched. Patients were included if they were ≥ 18 years old and had a lumbar MRI between January 1, 2006 and January 31, 2008, that showed a Modic 1 signal at a single level. The strength of the magnet was 1.5 T. MRI were reviewed by 2 assessors. Age and gender were recorded. MRI changes involving the intervertebral disc and the vertebral endplate subchondral bone were assessed for Modic 1 signal, intervertebral space narrowing, asymmetrical degenerative disc disease, spondylolisthesis, anterior and posterior intervertebral disc herniation, and anterior and lateral osteophytes. These outcomes were compared between >50%-IVSN Modic 1 and ≤50%-IVSN Modic 1 groups. For bivariate analysis, comparisons involved nonparametric Kruskal-Wallis test for quantitative variables and nonparametric Fisher’s exact test for qualitative variables. Multivariate analysis was conducted to determine factors independently associated with <50%-IVSN Modic 1 changes by backward stepwise regression. Informed consent and formal approval from Institutional Review Board is not required for this type of study. This statement was confirmed by our Institutional Review Board.ResultsMRI for 101 individuals were eligible. Patients’ mean (SD) age was 56.6(13.4) years, and 41/101(40.6%) were men. Modic 1 were most frequently observed at L4/L5 and L5/S1 (37[36.6%] cases each). As compared with >50%-IVSN Modic 1 patients, ≤50%-IVSN Modic 1 patients were younger (mean[SD] age 51.5[14.1] vs 58.8[12.6] years, p = 0.019), Modic 1 were more frequent at L5/S1 level (19[61.3%] vs 18[25.7%], p = 0.001), and anterior and lateral osteophytes were less frequent (13[41.9%] vs 55[78.6%], p < 0.001, and 11[35.5%] vs 48[68.6%], p = 0.002, respectively).Conclusions≤50%-IVSN Modic 1 are rather found in young men at L5/S1 level and are associated with less frequent osteophytes than >50%-IVSN Modic, while >50%-IVSN Modic 1 are rather found in older women at L4/L5 level.

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“…Fourteen out of 40 (35%) patients did not meet AxSpA criteria, and IBP could be explained by another cause: 100% had Degenerative Disc Disease (DDD). Although DDD tends to present with chronic mechanic lumbar pain, Modic I disc diseases may manifest with IBP characteristics [33,34]. In addition, DDD is most frequently found in older patients, not associated to acute phase reactant changes.…”

Section: Discussionmentioning

confidence: 99%

Impact of an Awareness Campaign for the Detection of Axial Spondyloarthritis in Patients with Inflammatory Back Pain

Schneeberger¹,

Citera²,

Buschiazzo³

et al. 2017

JRAD

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The objectives of the study are to identify patients with Inflammatory Back Pain (IBP) through an awareness campaign to the general population and to assess the impact of different advertising media. Methods:A four-week awareness campaign was presented through various communication media venues, raising awareness about AxSpA, and encouraging patients with IBP to contact us via e-mail or telephone call. If they met the inclusion criteria they were given an appointment. If the patient did not meet the diagnostic criteria at the first appointment, HLA-B27 and magnetic resonance imaging were performed.Results: A total of 900 patients replied (449 by telephone and 451 by e-mail). After excluding ineffective calls and emails, 587 patients were included (226from phone calls and 361from e-mails); 61.5% of this patients replied after seen a TV advertisement. Following the initial questionnaire, 70% of the patients from the call center and 7.3% via email met the inclusion criteria. 157 appointments were given, and only 80 (50.9%) attended. After clinical evaluation, 42 of the 80 patients (52.5%) definitively met the inclusion criteria. After clinical evaluations, 9 patients were classified as AxSpa. When we compared those with and without an AxSpA diagnosis, axial morning stiffness and higher enthesis score were significantly more frequent in the AxSpA group. Conclusion:The frequency of AxSpA in patients with IBP in our population was similar to that reported in literature. Television was clearly the best venue of communication, and the call center was the most effective way to contact potential patients.

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

Cited by 49 publications

References 23 publications

Low back pain patients and controls display functional differences in endplates and vertebrae measured with T2-mapping

Low back pain patients and controls display functional differences in endplates and vertebrae measured with T2-mapping

Intervertebral disc and vertebral endplate subchondral changes associated with Modic 1 changes of the lumbar spine: a cross-sectional study

Impact of an Awareness Campaign for the Detection of Axial Spondyloarthritis in Patients with Inflammatory Back Pain

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