Vertebroplasty in the treatment of recalcitrant lower back pain attributed to Modic 1 changes

Vertebroplasty is a recognised treatment for osteoporotic and pathological compression fractures. We present the case of TF, a 70-year-old male patient with a history of poor left ventricular function presenting with refractory lower back pain, thought to be secondary to Modic Type1 changes in the L2 and L3 vertebrae, accompanying L2-L3 degenerative disc disease. He was treated conservatively for approximately 9 months without success. Following recent suggestions that vertebroplasty may provide pain relief in patients with degenerative disc change and coexistent Modic 1 changes not responding to conservative treatment, we proceeded to vertebroplasty of the affected levels. This resulted in rapid resolution of pain and return to his pre low back pain level of activity. At 1-year follow-up the patient remains pain free. We review the causes of Modic 1 change, its relationship to low back pain and a rarely used but highly effective treatment option, percutaneous cement vertebroplasty, when it is unresponsive to traditional treatment options.