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ISSLS PRIZE IN BASIC SCIENCE 2017: Intervertebral disc/bone marrow cross-talk with Modic changes.

Stefan Dudli1, David C Sing2, Serena S Hu3

  • 1Department of Orthopaedic Surgery, University of California San Francisco, 513 Parnassus Ave, S-1164, San Francisco, CA, 94143, USA. dudli@panamerica.ch.

European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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PubMed
Summary
This summary is machine-generated.

Modic changes (MC) in the spine involve inflammatory and fibrogenic cross-talk between bone marrow and discs. This finding offers new therapeutic targets for treating MC-associated low back pain.

Keywords:
Bone marrowCross-talkFibrosisInflammationModic changeMyelopoiesisNeurotrophicOsteoclastogenesisPainPathobiology

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Area of Science:

  • Spinal pathology and regenerative medicine.
  • Biomarkers and molecular diagnostics.
  • Musculoskeletal research.

Background:

  • Modic Changes (MC) are vertebral bone marrow lesions associated with discogenic low back pain.
  • The underlying pathobiology of Modic Changes remains largely unknown.
  • Understanding MC pathobiology may reveal diagnostic and therapeutic targets.

Purpose of the Study:

  • To characterize the molecular and cellular features of Modic Changes (MC) bone marrow and adjacent intervertebral discs.
  • To investigate the potential biologic cross-talk between discs and bone marrow in the presence of MC.
  • To explore the diagnostic and therapeutic implications of MC-associated biologic activity.

Main Methods:

  • Cross-sectional cohort analysis of patients with Modic type 1 or 2 changes (MC1, MC2).
  • Collection of disc and bone marrow aspirates from MC levels and adjacent control levels.
  • Analysis of marrow cellularity, myelopoietic differentiation potential, gene expression profiles, and disc/bone marrow cross-talk.

Main Results:

  • Patients with MC1 and MC2 exhibited inflammatory dysmyelopoiesis and fibrogenic changes in bone marrow.
  • Pro-osteoclastic changes were observed in MC2 discs.
  • Up-regulation of neurotrophic receptors was noted in both MC bone marrow and discs.

Conclusions:

  • A fibrogenic and pro-inflammatory cross-talk exists between Modic Changes bone marrow and adjacent discs.
  • This cross-talk provides insight into the pain generation mechanisms at MC levels.
  • The findings inform novel therapeutic strategies for Modic Changes-associated low back pain.