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Modic vertebral body changes: the natural history as assessed by consecutive magnetic resonance imaging
Michael J Hutton1, Jens H Bayer, John M Powell
1Princess Elisabeth Orthopaedic Centre, Royal Devon & Exeter Hospital, Exeter, United Kingdom. mikehutton@me.com
Study Design:
Changes in the vertebral body adjacent to the end plate may be associated with degenerative disc disease. These changes can be separated on magnetic resonance imaging (MRI) and have been described by Modic. It is assumed that these end plate changes represent a process that is progressive.
Objective:
We have retrospectively reviewed patients who had sequential MRI of the lumbar spine to investigate the natural history of Modic vertebral body MRI changes.
Summary Of Background Data:
Of 36 end plates with Modic type 1 changes in a first MRI, 18 remained the same, 13 progressed to Modic type 2 change, 3 progressed to Modic type 3 changes, and 2 end plates were found to be normal (type 0) on a subsequent MRI. Of the 22 end plates initially reported as Modic type 2 in a first MRI, 18 remained unchanged, none converted to Modic type 3, and 4 converted from Modic type 2 to Modic type 1 on a subsequent MRI.
Methods:
Magnetic resonance (MR) images of the lumbar spine of 49 subjects were assessed by a senior spinal surgeon. The lumbar vertebral body adjacent to the end plate was classified by using the Modic system from L1 to S1 inclusive.
Results:
Of the 36 end plates with Modic 1 changes in the first data set, 18 remained the same; 13 progressed to Modic 2; 3 progressed to Modic 3 changes, and, interestingly, 2 end plates were found to be normal on the repeat scan. Of the 22 end plates initially reported as Modic 2, 18 remained unchanged; none converted to Modic 3 and 4 converted back from Modic 2 to Modic 1.
Conclusion:
Our findings reflect the dynamic nature of pathological changes in the spine and have demonstrated that Modic changes are reversible. They also raise further doubt that these MRI changes should be used as an indicator of clinical symptoms or of surgical outcome.
Insights
Modic changes on spinal MRI are not always progressive and can reverse. These vertebral body changes may not indicate clinical symptoms or predict surgical outcomes.
Area of Science:
- Spinal imaging and diagnostics
- Degenerative disc disease research
- Vertebral body pathology
Background:
- Modic changes are vertebral body MRI findings associated with degenerative disc disease.
- These changes were historically assumed to be a progressive pathological process.
- Understanding the natural history of Modic changes is crucial for accurate diagnosis.
Purpose of the Study:
- To investigate the natural history of Modic vertebral body MRI changes.
- To analyze the progression and reversibility of Modic changes using sequential lumbar spine MRIs.
- To evaluate the dynamic nature of end plate pathology.
Main Methods:
- Retrospective review of sequential lumbar spine MRI scans from 49 subjects.
- Assessment of vertebral bodies adjacent to end plates using the Modic classification system (L1-S1).
- Classification by a senior spinal surgeon to identify Modic types 1, 2, and 3, and normal (type 0).
Main Results:
- Of 36 Modic type 1 end plates, 18 remained unchanged, 13 progressed to type 2, 3 to type 3, and 2 normalized.
- Of 22 Modic type 2 end plates, 18 remained unchanged, none progressed to type 3, and 4 reverted to type 1.
- Demonstrated instances of Modic changes reverting to a less severe type or normalizing.
Conclusions:
- Modic changes exhibit a dynamic and reversible nature, challenging the assumption of constant progression.
- The reversibility of Modic changes suggests they may not be reliable indicators of clinical symptoms.
- Findings question the utility of Modic changes as a sole predictor of surgical outcomes.
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