Prevalence of modic changes in patients with low back pain and association with degenerative spinal findings: a...

Modic changes (MCs) are alterations in vertebral endplates visible on MRI and associated with various spinal pathologies, including disc degeneration, herniation, and spondylolisthesis. Despite their clinical significance, the associations between specific MC types and spinal pathologies require further investigation. This study aimed to investigate the prevalence and associations of MC types with demographic data and radiological findings in an Iranian population.

This retrospective cross-sectional study analyzed lumbar MRI scans from patients with low back pain. Patients with radiologically confirmed MCs met the inclusion criteria after excluding those with tumors, infections, fractures, or prior lumbar surgery. MCs were categorized into three types according to MRI signal characteristics. Associations between MC types and age, gender, disc degeneration, herniation, and spondylolisthesis were evaluated using statistical analysis.

Among 1350 patients evaluated, MCs were identified in 316 cases (23.4%), with Type 2 being the most prevalent (88.9%), followed by Type 1 (9.8%) and Type 3 (1.3%). MCs occurred most frequently at L4/L5 and L5/S1 levels. Type 1 MCs were significantly associated with younger age and disc herniation (p ≤ 0.05), while Type 2 MCs correlated with older age and moderate to severe disc degeneration (p ≤ 0.05). However, these associations did not remain statically significant after Bonferroni correction. Type 3 MCs were rare and predominantly observed in older patients. No significant gender differences in MC prevalence were observed, nor were there associations between any MC type and spondylolisthesis (P > 0.05).

Our findings suggest that Modic changes, particularly Type 2, are common radiological findings in lumbar spine imaging, most frequently occurring at L4/L5 and L5/S1 levels. Although initial associations with disc degeneration and herniation were observed, these did not remain significant after correction for multiple comparisons. Nonetheless, the distribution and age-related patterns of Modic changes suggest their potential relevance in degenerative spinal conditions. Future longitudinal studies should investigate the clinical implications and progression of Modic changes to inform more targeted management strategies for degenerative spinal disorders.