Is diabetes mellitus a risk factor for modic changes?: A novel model to understand the association between intervertebral disc degeneration and end-plate changes

Ekşi, Murat Şakir; Kara, Müjdat; Özcan-Ekşi, Emel Ece; Aytar, Murat Hamit; Güngör, Abuzer; Özgen, Serdar; Pamir, M. Necmettin

doi:10.1016/j.jos.2019.09.005

Cited by 21 publications

(7 citation statements)

References 33 publications

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“…32 Both severity and time span of diabetes are strongly associated with MC, but the association with severity of disc degeneration remains unclear. 33 Female patients, too obese and heavy physical work were all signi cantly associated with MC, and biomechanical factors appeared to play a critical role in the progressive changes in MC. 34 In our study, a signi cant number of patients engaged in excessive physical work, poor weight control or had various underlying diseases in rural areas(As shown in Table 1), which laid a hidden danger for clinical biomechanical changes, lumbar disc degeneration, and MC.…”

Section: Discussionmentioning

confidence: 96%

Clinical analysis of low back pain in patients with lumbar degenerative disc disease with Modic I/II changes after percutaneous transforaminal endoscopic discectomy: a retrospective study

Zhang

et al. 2023

Preprint

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Background Modic I/II has been associated with low back pain in some previous studies, but the majority of scholars still question this. This study investigated the changes of low back pain in patients with lumbar degenerative diseases and the recovery of low back and leg pain in patients after percutaneous transforaminal endoscopic lumbar discectomy (PTED) without fusion and decompression surgery alone. Methods Sixty-four patients (aged 57.86 ± 10.86 years) with lumbar degenerative diseases whose vertebral bone marrow showed Modic I/II signal were selected. All patients presented with low back and leg pain due to lumbar degeneration and underwent PTED without fusion. We evaluated changes in visual analogue scale (VAS) scores for low back pain and Oswestry disability index (ODI) before surgery, 1 month after surgery, 6 months after surgery, and 1 and 2 years after surgery. Results The mean age of the PTED group was 57.86 ± 10.86 years. The VAS leg, VAS back, and ODI scores were significantly improved after surgery compared with those before surgery. Notably, VAS back pain score and VAS leg pain score showed an increasing trend over time in the MCI group after PTED, and there were statistically significant differences in VAS back pain score and VAS leg pain score at 1 month and 2 years after surgery (P < 0.05). Conclusions PTED improves the condition of low back pain in patients with lumbar degenerative diseases. Low back pain in patients with lumbar degenerative diseases seems to arise primarily from nerve root compression, and the intuitive impact of MC on low back pain remains elusive. However, patients who presented with recurrent low back or leg pain within 2 years of surgery could be the result of progression of normal lumbar degeneration.

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Section: Discussionmentioning

confidence: 96%

Clinical analysis of low back pain in patients with lumbar degenerative disc disease with Modic I/II changes after percutaneous transforaminal endoscopic discectomy: a retrospective study

Zhang

et al. 2023

Preprint

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“…Indeed, it is sometimes difficult to distinguish between early PS and modic type 1 degenerative endplate changes, which are commonly associated with low back pain, because they both show similar MRI findings ( 11 ). Moreover, modic changes are recently reported to be associated with diabetes mellitus ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

Pyogenic spondylitis due to Streptococcus agalactiae with paraspinal abscess and vertebral destruction in a diabetic patient: time course of imagings

Kobayashi

Iwata

Handa

et al. 2023

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary A 76-year-old female with type 2 diabetes mellitus presented with hematuria, low back pain, and intermittent fever for 7 days. She was admitted to our hospital and diagnosed with Streptococcus agalactiae (GBS) bacteremia. CT showed an air density within the right iliopsoas muscle, and an MRI of the spine revealed hyperintensity in the right half of the L1–L2 intervertebral disk, leading to the diagnosis of a paraspinal abscess and L1–L2 pyogenic spondylitis. Antibiotic therapy was started and the clinical symptoms, as well as serologic biomarkers and radiologic images of the paraspinal abscess, were improved. The therapy was stopped on day 72 despite vertebral destruction progression. Vertebral endplate ossification was observed on day 108, and further bone formation was noted on day 177. Our case study with radiologic findings over 6 months demonstrated how bone destruction with pyogenic spondylitis, which had been treated with antibiotic therapy, improved after cessation of antibiotics. Learning points Although GBS is a rare cause of spondylitis, diabetic mellitus is a risk factor for the development of invasive GBS infections, especially under poor glycemic control. Bone destruction of pyogenic spondylitis can improve after discontinuation of antibiotic therapy. It may be important to decide the period of antibiotic therapy based on clinical conditions, serologic biomarkers, and soft tissue findings rather than bone findings. When elderly diabetic patients present with back pain and fever, spondylitis should be considered in the differential diagnosis to avoid potential diagnostic delays or misdiagnosis.

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“…Insu cient lumbar blood supply caused by aortic atherosclerosis and stenosis of the lumbar arteries has been associated with an increased risk of IDD [45][46][47][48]. On the other hand, the vertebral endplate could also be viewed as an end organ of vascular supply [11]. The associations between MCs and cardiovascular risk factors such as overweight/obesity and smoking have been established in previous studies [49,50].…”

Section: Discussionmentioning

confidence: 99%

“…Typically, MCs are classi ed into three types: type 1 MCs represent increased vascularization and edema, type 2 MCs indicate fatty marrow degeneration and type 3 MCs re ect bone sclerosis [9]. It has been proposed that the development of MCs is triggered by mechanical failure and the in ammatory response [11]. However, the etiology and potential risk factors for MCs have not yet been clearly elucidated.…”

Section: Introductionmentioning

confidence: 99%

The impact of dyslipidemia on lumbar intervertebral disc degeneration and vertebral endplate modic changes: a cross-sectional study of 1035 citizens in China

Yuan

Huang

Han

et al. 2023

Preprint

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Background: Intervertebral disc degeneration (IDD) and vertebral endplate Modic changes (MCs) are common lumbar degenerative phenotypes related to low back pain (LBP). Dyslipidemia has been linked to LBP but its associations with IDD and MCs have not been fully elucidated. The present study aimed to address the possible link between dyslipidemia, IDD and MCs in the Chinese population. Methods: 1035 citizens were enrolled in the study. The levels of serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) were collected. IDD was evaluated based on the Pfirrmann grading system and subjects with an average grade ≥3 were defined as having degeneration. MCs were classified into typical types 1, 2 and 3. Covariables, including age, sex, BMI and fasting plasma glucose, were included for the adjustment of the logistic analyses. Results: The degeneration group included 446 subjects while the nondegeneration group included 589 subjects. The degeneration group had significant higher levels of TC and LDL-C (p<0.001) whereas TG and HDL-C were not significant different between the two groups. TC and LDL-C concentrations were significantly positively correlated with average IDD grades (p<0.001). Multivariate logistic regression revealed that high TC (≥6.2 mmol/L, adjusted OR=1.775, 95% CI=1.209-2.606) and high LDL-C (≥4.1 mmol/L, adjusted OR=1.818, 95% CI=1.123-2.943) were independent risk factors for IDD. Type 1 MC presented in 84 (8.12%) subjects, type 2 MC presented in 244 (23.57%) subjects, type 3 MC presented in 27 (2.61%) subjects and no MC was observed in the remaining 680 (65.70%) subjects. The type 2 MC group demonstrated a higher level of TC, but the association between serum lipids and MCs could not be confirmed in further multivariate logistic regression. Conclusions: High TC (≥6.2 mmol/L) and LDL-C (≥4.1 mmol/L) concentrations were recognized as independent risk factors for IDD for citizens in China. However, the epidemiological association between dyslipidemia and MCs could not be determined. The biomolecular effect of excess serum cholesterol may play a vital role in the development of IDD. Hypolipidemic treatment, especially when targeting cholesterol, may provide new opportunities in the management of lumbar disc degenerative diseases.

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Is diabetes mellitus a risk factor for modic changes?: A novel model to understand the association between intervertebral disc degeneration and end-plate changes

Cited by 21 publications

References 33 publications

Clinical analysis of low back pain in patients with lumbar degenerative disc disease with Modic I/II changes after percutaneous transforaminal endoscopic discectomy: a retrospective study

Clinical analysis of low back pain in patients with lumbar degenerative disc disease with Modic I/II changes after percutaneous transforaminal endoscopic discectomy: a retrospective study

Pyogenic spondylitis due to Streptococcus agalactiae with paraspinal abscess and vertebral destruction in a diabetic patient: time course of imagings

The impact of dyslipidemia on lumbar intervertebral disc degeneration and vertebral endplate modic changes: a cross-sectional study of 1035 citizens in China

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