Longitudinal study of vertebral type-1 end-plate changes on MR of the lumbar spine

Abstract

The purpose of this study was to investigate the temporal evolution of type-1 end-plate changes on MRI in patients with degenerative disease of the lumbar spine and to evaluate whether any correlation exists between such evolution and the change in patients' symptoms. Forty-four patients with 48 Modic type-1 end-plate changes (low TI signal and high T2 signal) were studied. All patients had an initial and a follow-up non-contrast lumbar MRI with variable intervals between the studies (12-72 months). Severity of the end-plate changes was assessed by eyeball estimation. Correlation with patients' symptoms was studied with the help of the Visual Analogue Score (VAS), Oswestry Questionnaire Score (OQS) and patients' subjective assessment. Of the 48 disc levels with type-1 changes, 18 (37.5%) converted fully to type 2 (high T1 signal and intermediate to high T2 signal), 7 (14.6%) partially converted to type 2, 19 (39.6%) became worse (i.e. type 1 changes became more extensive) and 4 (8.3%) showed no change. Higher average VAS (5.7) and OQS (42.3) scores were noted in patients where there was worsening type-1 change and lower scores (3.8 and 27, respectively) were seen in those where there was conversion to type-2 change. These trends, however, did not reach statistical significance (P values 0.16 and 0.09 for VAS and OQS, respectively). The statistical relationship was stronger after exclusion of patients with confounding factors (i.e. changes in lumbar MRI other than end-plate changes that could independently explain the evolution of patients' symptoms) with P-values of 0.08 and 0.07 for VAS and OQS, respectively. Type-1 end-plate change represents a dynamic process and in a large majority of cases either converts to type-2 change or becomes more extensive. The evolution of type-1 change relates to change in patient's symptoms, but not to a statistically significant level.

MRI follow-up of subchondral signal abnormalities in a selected group of chronic low back pain patients

“…In one study, during a follow-up of 14 months subchondral hypointensities increased from 9 to 29% [2] but in another study, during a longer follow-up of 72 months most subchondral hypointensities converted to hyperintensities [16]. We found a similar trend: most (67%) hypointensities seemed to turn into hyperintensities or disappear, while most (65%) hyperintensities persisted or increased.…”

“…Subchondral hypointensities have been mainly found to convert to hyperintensities on T1WI [16,17], but some of them in contrast appear to enlarge [2,16]. Most follow-up studies on the natural course of subchondral signal abnormalities include patients with disc herniations [2,12,16,17,25].…”

“…Most follow-up studies on the natural course of subchondral signal abnormalities include patients with disc herniations [2,12,16,17,25].…”

Modic changes: “Age, si quid agis”

“…The conversion from a theoretically unstable Modic 1 to a more stable Modic 2 has been described by some authors [1,6,7,11]. Modic et al [7], in their first description of MC, performed a longitudinal study and had five out of six Type-1 MC patients presenting at least partial conversion to Type-2 MC in 14 months to 3 years.…”

“…Modic et al [7], in their first description of MC, performed a longitudinal study and had five out of six Type-1 MC patients presenting at least partial conversion to Type-2 MC in 14 months to 3 years. Mitra et al [6] studied sequential MRIs from patients with Modic 1 changes and had a complete (37.5%) or partial (14.5%) transformation to Modic 2 with time or a keeping in Modic 1 (48%), but never spontaneous regression.…”