ISSLS PRIZE in Clinical Science 2022: Epidemiology, risk factors and clinical impact of juvenile Modic changes in paediatric patients with low back pain

Mallow, G. Michael; Zepeda, David; Kuzel, Timothy G; Barajas, J. Nicolás; Aboushaala, Khaled; Nolte, Michael T.; Espinoza-Orías, Alejandro; Oh, Chulhong; Colman, Matthew W.; Kogan, Monica; Phillips, Frank M.; An, Howard S.; Samartzis, D

doi:10.1007/s00586-022-07125-x

Cited by 16 publications

(18 citation statements)

References 45 publications

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“…2,[7][8][9][10][11] Endplate modic changes can also develop in children with potential association with prolonged symptoms. 12 Spinal column abnormalities, such as disc degeneration, and Schmorl's nodes have been described in prior studies involving sports such as wrestling, gymnastics, tennis, and weight-lifting (26-90%). 11,[13][14][15][16][17][18][19] Variable results of back pain prevalence in young athletes have previously been reported, ranging between 1% and 94% with different sporting disciplines, 8,[19][20][21][22][23][24][25][26][27][28] with rowing and cross-country skiing both having a high lifetime prevalence of LBP.…”

Section: Introductionmentioning

confidence: 98%

“… 2 , 7–11 Endplate modic changes can also develop in children with potential association with prolonged symptoms. 12 …”

Section: Introductionmentioning

confidence: 99%

“… 13 , 24 Moreover, there is a need for follow-up studies to investigate if any complications develop later in life. 12 , 19 , 29 The present study is a longitudinal follow-up of a previously published baseline study of the same participants. 19 The baseline study showed significantly higher prevalence of spinal column abnormalities in skiers (82%) compared with non-athletes (54%), while the lifetime prevalence of back pain was not statistically different between skiers (50%) and non-athletes (44%).…”

Section: Introductionmentioning

confidence: 99%

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No Significant Change in MRI Abnormalities or Back Pain Prevalence in the Thoraco-Lumbar Spine of Young Elite Skiers Over a 2-Year Follow-Up

Witwit¹,

Hebelka²,

Aminoff³

et al. 2022

OAJSM

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Background Young athletes are at increasing risk for spinal column injuries due to overloading the spine with excessive sports activities, with potential development of complications later in life. Purpose The purpose of this 2-year follow-up study of young elite skiers and non-athletes was to investigate any potential change in the thoraco-lumbar findings on MRI and to outline any change in back pain prevalence with continuing sporting activity and age. Study Design Longitudinal cross-sectional study. Methods MRI of the thoraco-lumbar spine was performed on 30 skiers (mean age 20 years, female 43%) and 16 non-athletes (mean age 19, female 75%), available for the 2-year follow-up. The intervertebral discs were evaluated for signal, height, bulge/herniation, and additionally according to Pfirrmann classification, and the endplates were graded according to endplate defect score. Any of the following disc findings was defined as disc degenerative change: reduced signal, reduced height, bulge, or herniation. All participants answered a specific back pain questionnaire. Results No significant difference in spinal column abnormalities, nor back pain, was found between baseline and 2-year follow-up in neither skiers nor controls. There was significantly higher prevalence of disc degenerative changes in skiers (73%) than in non-athletes (44%, p =0.05). Skiers (63%) had significantly more Pfirrmann grade ≥3 discs compared to non-athletes (25%) ( p =0.03). There was no significant difference in number of endplates with score ≥4 between skiers and non-athletes (50% vs 38%, p =0.40) nor in lifetime prevalence of back pain between skiers (46%) and non-athletes (40%). Conclusion There was no significant change over time of the spinal column MRI abnormalities, nor back pain prevalence, during a 2-year follow-up of skiers and non-athletes. Young skiers had significantly higher prevalence of spine abnormalities compared with non-athletes. There was no significant difference of the back pain lifetime prevalence in skiers compared with non-athletes.

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Section: Introductionmentioning

confidence: 98%

“… 2 , 7–11 Endplate modic changes can also develop in children with potential association with prolonged symptoms. 12 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

No Significant Change in MRI Abnormalities or Back Pain Prevalence in the Thoraco-Lumbar Spine of Young Elite Skiers Over a 2-Year Follow-Up

Witwit¹,

Hebelka²,

Aminoff³

et al. 2022

OAJSM

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“…Chronic back pain is a prevalent musculoskeletal disorder and a major cause of disability with enormous socioeconomic burdens worldwide [1][2][3][4]. Back pain is highly associated with endplate (EP) defects in relation to Modic changes (MCs) and intervertebral disc (IVD) degeneration PMID: [5][6][7]. MCs are magnetic resonance imaging (MRI) evidence of inflammatory and fibrotic vertebral bone marrow lesions that associate with adjacent IVD degeneration and EP defects [5,[8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Lumbar endplate microfracture injury induces Modic-like changes, intervertebral disc degeneration and spinal cord sensitization – An In Vivo Rat Model

Wang

Lai

Gansau

et al. 2023

Preprint

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BACKGROUND CONTEXT: Endplate (EP) injury plays critical roles in painful IVD degeneration since Modic changes (MCs) are highly associated with pain. Models of EP microfracture that progress to painful conditions are needed to better understand pathophysiological mechanisms and screen therapeutics. PURPOSE: Establish in vivo rat lumbar EP microfracture model with painful phenotype. STUDY DESIGN/SETTING: In vivo rat study to characterize EP-injury model with characterization of IVD degeneration, vertebral bone marrow remodeling, spinal cord sensitization, and pain-related behaviors. METHODS: EP-driven degeneration was induced in 5-month-old male Sprague-Dawley rats L4-5 and L5-6 IVDs through the proximal vertebral body injury with intradiscal injections of TNFα (n=7) or PBS (n=6), compared to Sham (surgery without EP-injury, n=6). The EP-driven model was assessed for IVD height, histological degeneration, pain-like behaviors (hindpaw von Frey and forepaw grip test), lumbar spine MRI and μCT analyses, and spinal cord substance P. RESULTS: EP injuries induced IVD degeneration with decreased IVD height and MRI T2 values. EP injury with PBS and TNFα both showed MC type1-like changes on T1 and T2-weighted MRI, trabecular bone remodeling on μCT, and damage in cartilage EP adjacent to the injury. EP injuries caused significantly decreased paw withdrawal threshold and reduced grip forces, suggesting increased pain sensitivity and axial spinal discomfort. Spinal cord dorsal horn Substance P was significantly increased, indicating spinal cord sensitization. CONCLUSIONS: EP microfracture can induce crosstalk between vertebral bone marrow, IVD and spinal cord with chronic pain-like conditions. CLINICAL SIGNIFICANCE: This rat EP microfracture model of IVD degeneration was validated to induce MC-like changes and pain-like behaviors that we hope will be useful to screen therapies and improve treatment for EP-drive pain.

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“…Today, LBP is one of the most common problems worldwide [1][2][3][4]. LBP is the most common health problem in the European workforce [5].…”

Section: Introductionmentioning

confidence: 99%

Does the anesthesia technique of cesarean section cause persistent low back pain after delivery? A retrospective analysis

et al. 2022

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Objective Cesarean sections (CS) under spinal anesthesia may lead to newly developed low back pain (LBP) after anesthesia. The cause of this pain is still unknown. This subject was investigated. Methods The persistent LBP after the section was retrospectively analyzed in patients who were operated on under spinal or general anesthesia between January 1, 2018, and January 1, 2020. Result General anesthesia was used in 52 women, but 251 women were operated on under spinal anesthesia. Newly developed persistent LBP was detected in 57 (18,8%) of a total of 303 patients. Of those patients with LBP, general anesthesia was used in 14 of 52 (26,9%) patients, but 43 of 251 (17.1%) patients received spinal anesthesia. Baby weight after CS was the only variable associated with persistent LBP after 3 and 6 months ( P < 0.05) in multiple logistic regression analysis. Patient age and anesthesia type were not associated with persistent LBP ( P > 0.05). Conclusion This study shows anesthesia type as spinal or general was not associated with increased persistent LBP. Performing more spinal than general anesthesia in the cesarean section may be false data about the increased rate of LBP after CS.

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ISSLS PRIZE in Clinical Science 2022: Epidemiology, risk factors and clinical impact of juvenile Modic changes in paediatric patients with low back pain

Cited by 16 publications

References 45 publications

No Significant Change in MRI Abnormalities or Back Pain Prevalence in the Thoraco-Lumbar Spine of Young Elite Skiers Over a 2-Year Follow-Up

No Significant Change in MRI Abnormalities or Back Pain Prevalence in the Thoraco-Lumbar Spine of Young Elite Skiers Over a 2-Year Follow-Up

Lumbar endplate microfracture injury induces Modic-like changes, intervertebral disc degeneration and spinal cord sensitization – An In Vivo Rat Model

Does the anesthesia technique of cesarean section cause persistent low back pain after delivery? A retrospective analysis

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