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Degenerative marrow (modic) changes on cervical spine magnetic resonance imaging scans: prevalence, inter- and
Eugen Mann1, Cynthia K Peterson, Juerg Hodler
1Radiology Department, Orthopaedic University Hospital Balgrist, Zürich, Switzerland.
Study Design:
A prevalence and reliability study of Modic changes (MCs) in the cervical spine.
Objective:
To assess the prevalence and reliability of diagnosing and classifying MCs and their relationship to disc herniations (DHs) in the cervical spine.
Summary Of Background Data:
Degenerative marrow (Modic) changes in the spine can be seen on MRI with some evidence linking them to pain. Many studies have been published on MCs in the lumbar spine, but only one small prevalence study focusing on MCs in the cervical spine has been reported.
Methods:
The cervical magnetic resonance imaging (MRI) scans of 500 patients over the age of 50 were retrospectively evaluated for the prevalence, type, and location of MCs and DHs. Two hundred of these same scans were independently analyzed by a second observer to evaluate interobserver reliability of diagnosis with 100 re-evaluated by the same observer 1 month later to assess intraobserver reliability. The SPSS program and Kappa statistics were used to assess prevalence and reliability. The risk ratio comparison of DH and MC was calculated.
Results:
Four hundred and twenty-six patients (85.2%) met the inclusion criteria. MCs were observed in 40.4% of patients (14.4% of all motion segments). A 4.3% were type 1 and 10.1% were type 2. DH were seen in 78.2% of patients (13.3% of motion segments). Both MC and DH were most frequently observed at C5/6 and C6/7. Disc extrusions were positively associated with MC (RR=2.4). The reliability showed an upper moderate interobserver (k=0.54) and an almost perfect intraobserver agreement (k=0.82).
Conclusion:
A high prevalence of MCs was observed with type 2 predominating. The C5/6 and C6/7 levels are most effected. Patients with MC are more likely to have a DH at the same level. MC type 2 predominates. The classification is reliable.
Insights
Modic changes (MCs) are common in the cervical spine, particularly at C5/6 and C6/7 levels, with type 2 predominating. These degenerative changes are reliably diagnosed and associated with disc herniations (DHs).
Area of Science:
- Radiology
- Spinal Imaging
- Degenerative Disc Disease
Background:
- Modic changes (MCs) are MRI-visible spinal degenerations linked to pain.
- Cervical spine MC research is limited compared to lumbar spine studies.
- Prevalence and reliability of cervical MCs require further investigation.
Purpose of the Study:
- To determine the prevalence, type, and location of cervical spine Modic changes (MCs).
- To assess the diagnostic reliability (inter- and intraobserver) of MCs.
- To evaluate the association between cervical MCs and disc herniations (DHs).
Main Methods:
- Retrospective analysis of 500 cervical MRI scans from patients over 50.
- Evaluation of MCs and DHs prevalence, type, and location.
- Inter- and intraobserver reliability assessed using Kappa statistics on 200 and 100 scans, respectively.
Main Results:
- MCs found in 40.4% of patients; Type 2 MCs were more prevalent (10.1%).
- Cervical spine levels C5/6 and C6/7 showed the highest prevalence for both MCs and DHs.
- Disc extrusions positively associated with MCs (RR=2.4); high intraobserver (k=0.82) and moderate interobserver (k=0.54) reliability.
Conclusions:
- High prevalence of cervical Modic changes (MCs), with Type 2 predominating.
- C5/6 and C6/7 are the most affected spinal levels.
- Cervical MC diagnosis is reliable and associated with disc herniations, especially disc extrusions.
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