Modic Changes on MR Images as Studied with Provocative Diskography: Clinical Relevance—A Retrospective Study of 2457 Disks

Thompson, Kerry J.; Dagher, Azar P.; Eckel, Timothy S.; Clark, Michael; Reinig, J W

doi:10.1148/radiol.2503080474

Cited by 121 publications

(94 citation statements)

References 14 publications

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“…Positive associations between MCs and LBP were found with odds ratios (ORs) ranging from 2 to 20. More recently, three additional studies [20,27,32] reported similar findings, in which ORs for this association were 5, 9 and 28.…”

Section: Introductionmentioning

confidence: 57%

“…One of these studies [32] reported a higher positive predictive value for pain generation with discography for MCs Type I (0.81) than for MCs Type II or III (0.64 and 0.57, respectively). In a non-clinical population, Kjaer et al [15] found that analysing MCs Type I separately from the other types increased the strength of the association between MCs and LBP.…”

Section: Introductionmentioning

confidence: 99%

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Is the development of Modic changes associated with clinical symptoms? A 14-month cohort study with MRI

et al. 2012

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Purpose Modic changes (MCs) have been suggested to be a diagnostic subgroup of low back pain (LBP). However, the clinical implications of MCs remain unclear. For this reason, the aims of this study were to investigate how MCs developed over a 14-month period and if changes in the size and/or the pathological type of MCs were associated with changes in clinical symptoms in a cohort of patients with persistent LBP and MCs. Methods Information on LBP intensity and detailed information from MRI on the presence, type and size of MCs was collected at baseline and follow-up. Changes in type (Type I, II, III and mixed types) and size of MCs were quantified at both time points according to a standardised evaluation protocol. The associations between change in type, change in size and change in LBP intensity were calculated using odds ratios (ORs). Results Approximately 40 % of the MCs followed the expected developmental path from Type I (here Type I or I/II) to Type II (here Type II or II/III) or Type I to Type I/II. In general, the bigger the size of the MC at baseline, the more likely it was that it remained unchanged in size after 14 months. Patients who had MC Type I at both baseline and 14-month follow-up were less likely to experience an improvement in their LBP intensity as compared to patients who did not have Type I changes at both time points (OR 7.2, CI 1.3-37). There was no association between change in size of MCs Type I and change in LBP intensity. Conclusions The presence of MCs Type I at both baseline and follow-up is associated with a poor outcome in patients with persistent LBP and MCs.

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Section: Introductionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Is the development of Modic changes associated with clinical symptoms? A 14-month cohort study with MRI

et al. 2012

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“…Positive associations between MCs and LBP were found with odds ratios (ORs) ranging from 2 to 20 [9]. More recently, three additional studies [10-12] reported similar findings, in which ORs for the association were 5, 9 and 28. Although believed to be associated with disc degeneration, the precise etiology of MCs is unknown.…”

Section: Introductionmentioning

confidence: 83%

Rest versus exercise as treatment for patients with low back pain and Modic changes. a randomized controlled clinical trial

Jensen

Leboeuf‐Yde

Wedderkopp

et al. 2012

BMC Med

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BackgroundClinical experience suggests that many patients with Modic changes have relatively severe and persistent low back pain (LBP), which typically appears to be resistant to treatment. Exercise therapy is the recommended treatment for chronic LBP, however, due to their underlying pathology, Modic changes might be a diagnostic subgroup that does not benefit from exercise. The objective of this study was to compare the current state-of-the art treatment approach (exercise and staying active) with a new approach (load reduction and daily rest) for people with Modic changes using a randomized controlled trial design.MethodsParticipants were patients from an outpatient clinic with persistent LBP and Modic changes. They were allocated using minimization to either rest therapy for 10 weeks with a recommendation to rest for two hours daily and the option of using a flexible lumbar belt or exercise therapy once a week for 10 weeks. Follow-up was at 10 weeks after recruitment and 52 weeks after intervention and the clinical outcome measures were pain, disability, general health and global assessment, supplemented by weekly information on low back problems and sick leave measured by short text message (SMS) tracking.ResultsIn total, 100 patients were included in the study. Data on 87 patients at 10 weeks and 96 patients at one-year follow-up were available and were used in the intention-to-treat analysis. No statistically significant differences were found between the two intervention groups on any outcome.ConclusionsNo differences were found between the two treatment approaches, 'rest and reduced load' and 'exercise and staying active', in patients with persistent LBP and Modic changes.Trial RegistrationClinicalTrials.gov: NCT00454792

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“…10 It has been shown that there is a significant correlation between Modic changes and pain provocation at discography, suggesting that they can be a predictive sign of low back pain. 11,12 In several longitudinal studies Modic changes have been shown to vary with the passage of time. 13,14 Hutton, Bayer and Powell 14 found that, of 36 endplates with Modic type 1 changes in the first MRI study, 18 remained the same, 13 progressed to type 2, three progressed to type 3, and two became normal, at a mean follow-up of 1.9 years.…”

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confidence: 99%

Modic changes in the cervical spine

Matsumoto

Okada

Ichihara

et al. 2012

The Journal of Bone and Joint Surgery. British volume

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We conducted a prospective follow-up MRI study of originally asymptomatic healthy subjects to clarify the development of Modic changes in the cervical spine over a ten-year period and to identify related factors. Previously, 497 asymptomatic healthy volunteers with no history of cervical trauma or surgery underwent MRI. Of these, 223 underwent a second MRI at a mean follow-up of 11.6 years (10 to 12.7). These 223 subjects comprised 133 men and 100 women with a mean age at second MRI of 50.5 years (23 to 83). Modic changes were classified as not present and types 1 to 3. Changes in Modic types over time and relationships between Modic changes and progression of degeneration of the disc or clinical symptoms were evaluated. A total of 31 subjects (13.9%) showed Modic changes at followup: type 1 in nine, type 2 in 18, type 3 in two, and types 1 and 2 in two. Modic changes at follow-up were significantly associated with numbness or pain in the arm, but not with neck pain or shoulder stiffness. Age (≥ 40 years), gender (male), and pre-existing disc degeneration were significantly associated with newly developed Modic changes.In the cervical spine over a ten-year period, type 2 Modic changes developed most frequently. Newly developed Modic changes were significantly associated with age, gender, and pre-existing disc degeneration.Degenerative changes of the vertebral bodies adjacent to intervertebral discs seen on MRI are known as Modic changes.

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Modic Changes on MR Images as Studied with Provocative Diskography: Clinical Relevance—A Retrospective Study of 2457 Disks

Abstract: Type 1 signal intensity changes on MR images have a high positive predictive value in the identification of a pain generator.

Cited by 121 publications

References 14 publications

Is the development of Modic changes associated with clinical symptoms? A 14-month cohort study with MRI

Is the development of Modic changes associated with clinical symptoms? A 14-month cohort study with MRI

Rest versus exercise as treatment for patients with low back pain and Modic changes. a randomized controlled clinical trial

Modic changes in the cervical spine

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