Spinopelvic alignment predicts disc calcification, displacement, and Modic changes: Evidence of an evolutionary etiology for clinically‐relevant spinal phenotypes

Abstract

Lumbar disc‐displacement, Modic changes (MCs), and UTE Disc Sign (UDS) on MRI are clinically relevant spinal phenotypes that can lead to sciatica/LBP. Not all degenerated discs result in disc‐displacement, MCs and UDS, suggesting varied etiologies. Spinopelvic parameters have been implicated in various spinal disorders. Pelvic incidence (PI) is “fixed parameter” since skeletal maturity. No study has addressed disc‐displacement, MCs and UDS in context of spinopelvic parameters. Therefore, the aim of study was to determine if spinopelvic parameters are associated and predict clinically‐relevant MRI‐phenotypes. One hundred and eight population‐based subjects (mean age: 52.3 years) were recruited. Spondylolisthesis and scoliosis individuals were excluded. Lumbar lordosis (LL), PI, sacral slope (SS), and pelvic tilt (PT) were assessed on lateral plain radiographs. Disc degeneration was assessed and summated, and presence or not of disc‐displacement and MCs were noted on T2W MRI. UDS was detected on UTE. Following exclusion criteria, 95 subjects were assessed. Disc‐displacement (82.1%), MCs (52.6%), and UDS (37.9%) were associated with lower PI, SS, LL, and LL/PI index. On multivariate analyses, lower PI was significantly related to development of these MRI phenotypes (adjusted OR range:0.95‐0.92; P < .05), with critical PI value of 42° or lower exhibiting fourfold increase risk of combined phenotypes (P = .020). Of UDS discs, 39.3% had adjacent MCs and 83.6% had disc‐displacement. 87.5% of MC had directly adjacent UDS. The first study to note that PI may “predict” the development of disc‐displacement, MCs and UDS, suggesting potential sub‐variants and mechanistic susceptibility that may be grounded in spinopelvic evolution. An “evolutionary etiological pathway” of spinal phenotype development is proposed.

Modic changes - An evidence-based, narrative review on its patho-physiology, clinical significance and role in chronic low back pain

“…12 The two main arms of endplate research are Modic changes (MC) and endplate lesions (Schmorl's nodes/fractures/erosions/calcifications). 13,14 The concept of MC is well-known over the past 30 years and is one of the highly controversial topics till date. 15e20 The current literature review comprehensively discusses various issues regarding MC including historical details, etiology, patho-biology, clinical features, causative role in back pain and other treatment considerations.…”

“…32,33 Recent studies have demonstrated strong associations between sagittal spino-pelvic alignment and MC. While Zehra et al 14 demonstrated significantly greater prevalence of MC in patients with low pelvic incidence (42 ), Chen et al 12 showed greater association of high lumbar lordosis (LL) and higher L4-5 lordotic angle with MC.…”

“…In a survey involving 55 participants, 84% and 80% of clinicians and researchers respectively, acknowledged significant variations in the existing nomenclature and understanding of endplate pathologies and emphasized upon the need for standardized nomenclature. 14…”

Basivertebral Nerve Ablation for the Treatment of Vertebrogenic Pain

“…It is also important to note that the anatomy of the vertebral column varies throughout the population. Variables that have a range within the population regarding VBP include pelvic incidence, pelvic tilt, and sacral slope [49].…”

“…This may also be related to the development of CLBP in some patients and not others. Additional research is needed to determine this relationship and how anatomy can be further studied to optimize treatment [49].…”