Modic type III lesions and Schmorl's nodes are the same pathological changes?

Degenerative disc disease (DDD) is a major health problem worldwide. Both Modic lesions and Schmorl's nodes are considered to correlate with DDD such as low back pain. Modic lesions are the changes of degenerative vertebral endplate and adjacent bone marrow observed on magnetic resonance imaging and are divided into three types. Modic type III lesions are thought to represent extensive subchondral bone sclerosis within the bone marrow of adjacent endplate. The pathological performance of Schmorl's nodes is cystic lesions around indistinct sclerotic margins and beneath the cartilaginous endplate. Coincidently, there are many similarities between Modic type III lesions and Schmorl's nodes including pathological appearances, pathogenetic location and related diseases.

We hypothesize that Modic type III lesions and Schmorl's nodes are the same pathological changes, and Modic type III lesions may be the quiescent or incipient pathology phrase of Schmorl's nodes. The clinical symptoms of DDD are also accompanied by emergence of these pathological changes.

A longitudinal study could be used to test this hypothesis. We could measure and analyze whether Modic type III lesions have increased in size or evolved into Schmorl's nodes as time goes on.

This hypothesis explains the possible pathologic process of Modic type III lesions and Schmorl's nodes. If the hypothesis were conformed, Modic type III lesions and Schmorl's nodes will be rediscovered, which provides the new basis for the clinical treatment of DDD. In additions, this hypothesis also has crucial significances for the classification of Modic lesions.