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Modic changes - An evidence-based, narrative review on its patho-physiology, clinical significance and role in
Vibhu Krishnan Viswanathan1, Ajoy Prasad Shetty1, S Rajasekaran1,2
1Department of Spine Surgery, Ganga Medical Center and Hospitals, Coimbatore, India.
Objective:
Lumbar degenerative spinal ailments are the most important causes for chronic low back pain. Modic changes (MC) are vertebral bone marrow signal intensity changes seen on MRI, commonly in association with degenerative disc disease (DDD). Despite being widely studied, majority of issues concerning MC are still controversial. The current narrative, evidence-based review comprehensively discusses the various aspects related to MC.
Literature Search:
An elaborate search was made using keywords "Modic changes", "lumbar Modic changes", "Modic changes in lumbar spine", and "vertebral Endplate Spinal Changes", on pubmed and google (scholar.google.com) databases on the 3rd of March 2020. We identified crucial questions regarding Modic changes and included relevant articles pertaining to these topics for this narrative review.
Results:
The initial search using the keywords "Modic changes", "lumbar Modic changes", "Modic changes in lumbar spine", and "vertebral Endplate Spinal Changes" on pubmed yielded a total of 568, 412, 394 and 216 articles on "pubmed" database, respectively. A similar search using the aforementioned keywords yielded a total of 3650, 3548, 3726 and 21570 articles on "google scholar" database. The initial screening involved exclusion of duplicate articles, articles unrelated to MC, animal or other non-clinical studies, and articles in non-English literature based on abstracts or the titles of articles. This initial screening resulted in the identification of 405 articles. Full manuscripts were obtained for all these selected articles and thoroughly scrutinised at the second stage of article selection. All articles not concerning Modic changes, not pertaining to concerned questions, articles concerning other degenerative phenomena, articles discussing cervical or thoracic MC, case reports or animal studies, articles in non-English language and duplicate articles were excluded. Review articles, randomised controlled trials and level 1 studies were given preference. Overall, 69 articles were included in this review.
Conclusion:
Modic change (MC) is a dynamic phenomenon and its true etiology is still not definitely known. Disc/end plate injury, occult discitis and autoimmune reactions seem to trigger an inflammatory cascade, which leads to their development. Male sex, older age, diabetes mellitus, genetic factors, smoking, obesity, spinal deformities, higher occupational loads and DDD are known risk factors. There is no conclusive evidence on the causative role of MC in chronic low back pain (LBP) or any influence on the long term outcome in patients with LBP or lumbar disc herniations (LDH). Patients with MC have been reported to have less satisfactory outcome following conservative treatment or discectomy, although the evidence is still unclear.
Insights
Modic changes (MC) are vertebral bone marrow signal intensity changes linked to low back pain, but their exact cause and effect remain unclear. This review discusses MC, risk factors, and their controversial role in chronic low back pain outcomes.
Area of Science:
- Orthopedics
- Radiology
- Spinal Health
Background:
- Lumbar degenerative spinal ailments are a primary cause of chronic low back pain.
- Modic changes (MC) are MRI-detected vertebral bone marrow signal intensity changes often associated with degenerative disc disease (DDD).
- Despite extensive study, many aspects of MC remain controversial.
Purpose of the Study:
- To comprehensively review various aspects of Modic changes (MC).
- To discuss the etiology, risk factors, and clinical significance of MC in the context of low back pain.
Main Methods:
- A narrative, evidence-based review was conducted.
- Keywords "Modic changes", "lumbar Modic changes", "Modic changes in lumbar spine", and "vertebral Endplate Spinal Changes" were used for literature search on PubMed and Google Scholar.
- Articles were screened for relevance, excluding duplicates, non-clinical studies, and non-English literature, with a preference for high-level evidence.
Main Results:
- An initial search yielded hundreds of articles across databases.
- After rigorous screening and exclusion criteria, 69 articles were included in the review.
- Modic changes (MC) are dynamic, with uncertain etiology, possibly involving disc/endplate injury, occult discitis, or autoimmune reactions.
Conclusions:
- Known risk factors for MC include male sex, older age, diabetes, genetics, smoking, obesity, spinal deformities, occupational load, and DDD.
- There is no conclusive evidence linking MC directly to chronic low back pain (LBP) causation or long-term outcomes in LBP or lumbar disc herniation (LDH).
- Outcomes for patients with MC following conservative treatment or discectomy are reported as less satisfactory, though evidence remains unclear.
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