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Incidence and risk factors for modic changes in the lumbar spine: a systematic review and meta-analysis
Zhenyu Cao1,2,3, Mingtao Zhang1,2, Jingwen Jia1,2
1Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China.
Background:
Modic changes refer to bone marrow alterations beneath vertebral endplates and are potentially linked to infection, trauma, disc degeneration, scoliosis, and other pathological conditions. Systematic evaluations of their incidence and associated risk factors in the lumbar spine are lacking. This study aimed to analyze and evaluate the incidence and risk factors of Modic changes in lumbar spine disorders.
Methods:
A comprehensive systematic review was conducted using Web of Science, PubMed, Cochrane Library, and Embase databases. Eligible studies reported the incidence and associated risk factors of Modic changes in the lumbar spine. Data were extracted and systematically analyzed from the selected studies, and meta-analyses were conducted employing random or fixed effects models.
Results:
Twenty-five studies were included in the meta-analysis. The overall incidence of Modic changes was 35%. Six risk factors were identified and quantitatively assessed. Strong evidence supported the association of endplate changes (OR=3.56; 95% CI=2.00 to 6.32; p<0.0001); moderate evidence supported the association of age (OR=4.01; 95% CI=1.37 to 6.65; p=0.003), disc degeneration (OR=8.54; 95% CI=1.98 to 36.73; p=0.004), and lumbar lordosis angle (OR=-4.14; 95% CI=-6.79 to -1.49; p=0.002); minor evidence supported the association of spondylolisthesis (OR=2.00; 95% CI=1.12 to 3.58; p=0.02) and physical labor (OR=1.81; 95% CI=1.08 to 3.04; p=0.03) with the occurrence of Modic changes in the lumbar spine. No significant associations were found to support body mass index, sex, disc herniation, smoking, distributional segmentation, or sacral slope angle as risk factors for Modic changes in the lumbar spine.
Conclusion:
Modic changes occur in 35% of lumbar spine cases, with advanced age, disc degeneration, endplate changes, spondylolisthesis, reduced anterior lumbar lordosis angles, and participation in physical labor identified as associated risk factors.
Insights
Modic changes affect 35% of lumbar spine cases. Key risk factors include age, disc degeneration, endplate changes, spondylolisthesis, reduced lordosis, and physical labor.
Area of Science:
- Spinal Imaging and Diagnostics
- Orthopedic Research
- Radiology
Background:
- Modic changes are bone marrow alterations under vertebral endplates.
- These changes are linked to various spinal conditions like degeneration and trauma.
- Systematic data on Modic changes incidence and risk factors in the lumbar spine are limited.
Purpose of the Study:
- To systematically evaluate the incidence of Modic changes in the lumbar spine.
- To identify and assess associated risk factors for Modic changes.
- To provide a comprehensive overview for clinical and research applications.
Main Methods:
- A systematic review of multiple databases (Web of Science, PubMed, Cochrane, Embase) was performed.
- Data from eligible studies on Modic changes incidence and risk factors were extracted.
- Meta-analyses using random or fixed effects models were conducted for quantitative assessment.
Main Results:
- The overall incidence of Modic changes in the lumbar spine was found to be 35%.
- Six risk factors were identified: endplate changes (strong evidence), age, disc degeneration, lumbar lordosis angle (moderate evidence), spondylolisthesis, and physical labor (minor evidence).
- No significant association was found with BMI, sex, disc herniation, smoking, or sacral slope angle.
Conclusions:
- Modic changes are prevalent, occurring in 35% of lumbar spine cases.
- Significant risk factors include advanced age, disc degeneration, endplate changes, spondylolisthesis, reduced lordosis, and physical labor.
- These findings aid in understanding Modic changes and their clinical implications.
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