Phenotype profiling of Modic changes of the lumbar spine and its association with other MRI phenotypes: a large-scale population-based study

Juhani H Määttä; Jaro I Karppinen; Keith D K Luk; Kenneth M C Cheung; Dino Samartzis

doi:10.1016/j.spinee.2015.06.056

Phenotype profiling of Modic changes of the lumbar spine and its association with other MRI phenotypes: a large-scale population-based study

Spine J. 2015 Sep 1;15(9):1933-42. doi: 10.1016/j.spinee.2015.06.056. Epub 2015 Jun 29.

Authors

Juhani H Määttä¹, Jaro I Karppinen², Keith D K Luk³, Kenneth M C Cheung⁴, Dino Samartzis⁵

Affiliations

¹ Department of Physical and Rehabilitation Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Box 5000, 90014 Oulu, Finland.
² Department of Physical and Rehabilitation Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Box 5000, 90014 Oulu, Finland; Finnish Institute of Occupational Health, Health and Work Ability, Aapistie 1, 90220 Oulu, Finland.
³ Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Rd, Pokfulam, Hong Kong, SAR, China.
⁴ Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Rd, Pokfulam, Hong Kong, SAR, China. Electronic address: cheungmc@hku.hk.
⁵ Department of Orthopaedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Rd, Pokfulam, Hong Kong, SAR, China. Electronic address: dsamartzis@msn.com.

PMID: 26133258
DOI: 10.1016/j.spinee.2015.06.056

Abstract

Background context: Modic changes (MC) are associated with low back pain. They represent vertebral endplate and adjacent vertebral marrow changes on magnetic resonance imaging (MRI), classified into three types. Because of small sample sizes, patient cohorts, and limited phenotype assessment, the morphology and involvement of MC and their association with other spinal phenotypes remain speculative.

Purpose: We addressed and proposed a phenotypic profiling of MC and their relationship with lumbar MRI phenotypes in a large-scale population-based study.

Study design/setting: A cross-sectional study of the Hong Kong Disc Degeneration Cohort.

Patient sample: The study population consisted of 1,546 Southern Chinese volunteers.

Outcome measures: Topographical and morphological dimensions of MC, presence of disc degeneration (DD) and displacement, and Schmorl nodes were evaluated.

Methods: Axial T1-weighted and sagittal T2-weighted MRIs (3T) were assessed.

Results: Females were 62.4% (mean age, 49 years). The overall prevalence of MC was 21.9% (6.3% Type I and 15.5% Type II). Of all MC, 76% were located at the two lowest lumbar levels. Modic changes at the two lowest lumbar levels were more commonly located laterally (p<.001), less commonly anteriorly (p<.001), and were more extensive horizontally (p=.006) but not in vertical height compared with the upper levels. Type I MC were less common in the anterior part (p=.022), larger in size (height p=.004), and affected more likely the whole horizontal plane (p=.016) than Type II MC. Modic changes were associated with disc displacement, Schmorl nodes, and DD at the affected level (all p<.001), and the strength of association increased with the size of the lesion. Type I MC were associated more strongly with disc displacement (p=.008) and DD (p=.022) than Type II MC.

Conclusions: Our large-scale MRI study is the first to definitely note that MC were size- and type-dependently significantly associated with disc pathology and endplate abnormalities. Our phenotype profiling of MC may have clinical utility.

Keywords: Degeneration; Disc; Displacement; Endplate; Epidemiology; Magnetic resonance imaging; Modic changes; Phenotype; Schmorl nodes.

Publication types

Evaluation Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Female
Humans
Intervertebral Disc Degeneration / diagnosis*
Low Back Pain / diagnosis*
Lumbosacral Region / pathology*
Magnetic Resonance Imaging*
Male
Middle Aged
Phenotype*