A Three-Year Follow-up of Lumbar Spine Endplate (Modic) Changes

Mari Kuisma, MD; Jaro Karppinen, MD, DMSc; Jaakko Niinimäki, MD; Mauno Kurunlahti, MD, DMSc; Marianne Haapea, MSc; Heikki Vanharanta, MD, DMSc; Osmo Tervonen, MD, DMSc

Disclosures

Spine. 2006;31(15):1714-1718. 

In This Article

Results

Evaluation of Modic changes showed good agreement between the radiologists, with a kappa value of 0.64 (n = 60 at baseline and at 3 years). Test-retest agreement was 0.90 (n = 60).

The prevalence of Modic changes at baseline was 23% (70 of 300 discs). The Modic changes included seven mixed Type I/II and 63 Type II changes. No types I, III, or II/III changes were identified at baseline. Table 1 presents the occurrence of different types of Modic changes by disc level. Changes typically occurred at L4-L5 and L5-S1, 79% of changes being located at these two levels. Modic changes at baseline associated positively with age (P = 0.009), but not with physical workload.

Modic changes at baseline were usually observed in parallel on both sides of the disc (52 of 300 discs, 34 patients), although in some cases only superior (9 of 300 discs, 9 patients) or inferior (9 of 300 discs, 8 patients) margins were involved. Although changes usually affected the whole anteroposterior length of the disc margin (53 of 300 discs, 38 patients), occasionally only the anterior (8 of 300 discs, 8 patients) or posterior (9 of 300 discs, 7 patients) margins of the vertebral body were involved. Vertical depth varied between 3 and 30 mm (mean, 11.8 mm). The extent of changes was 25% or less of the endplate area in 22 discs (18 patients), 26% to 50% in 25 discs (22 patients), and more than 50% in 23 discs (18 patients). The depth and extent of changes were greatest at L4-L5 and L5-S1 ( Table 2 ).

Sixty of 70 discs (86%; 37 patients) with Modic changes at baseline did not alter Modic type during the 3-year follow-up. However, progression in the extent of these lesions was observed, as the vertical depth of Type II and mixed Type I/II Modic changes, and the extent of the endplate area of Type II lesions increased significantly (P = 0.002, P = 0.045 and P = 0.001, respectively).

Ten of 70 discs (14%; 9 patients) with Modic changes at baseline displayed another type at 3 years; two converted from mixed Type I/II to Type II, six from Type II to mixed Type I/II, and two from Type II to Type I (Figures 2, 3). Most of converted changes were localized at L5-S1 (6 of 10) and colocalized with a symptomatic disc herniation (8 of 10).

New (N = 13; solid lines) and converted (N = 10; dashed lines) Modic changes over the 3-year follow-up. All disc levels are presented together (N = 300 in 60 patients).

Modic Type II change converted to Modic Type I. a and b, There is Grade 2 disc degeneration and a small Modic Type II change (open arrows) in the superoposterior aspect of the L5 vertebral body. c and d, After 3 years of follow-up, there is Grade 3 disc degeneration. On the superoposterior aspect of the L5 vertebral body has appeared, a large Type I Modic change (arrows) and a new Schmorls' node (arrowhead).

Thirteen of 230 discs (6%; 13 patients) with no Modic changes at baseline had a new incident Modic change at the 3-year follow-up MRI. Seven of these new changes were Type I, three were Type II, and three were mixed Type I/II (Figure 2). All discs adjacent to a new Modic change had at least Grade 1 disc degeneration at baseline. Most of new Modic changes were localized also at L4-L5 or L5-S1 (10 of 13), and colocalized with a symptomatic disc herniation (8 of 13). Converted or new Modic changes were not associated with age or physical workload.

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