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Objective: To determine the frequency and distribution of endplate modic changes in lumbar spine on Magnetic Resonance Imaging (MRI) of lumbar spine of patients with low back pain.
Methodology: This cross sectional study was conducted in department of radiology, Hayatabad Medical Complex, Peshawar from January to June 2020. A total 500 patients of both genders were included. MRI films were evaluated by Radiologist with 5 years’ experience. Endplate modic changes were classified according to definition by Modic et al. Frequency and distribution of modic changes were assessed at L1-L2, L2-L3, L3-L4, L4-L5 and L5-S1 levels.
Results: In our study, a total of 386 patients showed endplate modic changes. The mean age of the sample was 41.0+15.16 years. There were 190 (47.4% ) males and 196 (52.6%) females. Type 2 modic changes were found in 192 (49.7%) patients while 161 (41.7%) had type 3 modic changes and 33 (8.5%) had type 1 modic changes.
Conclusion: Endplate modic changes occur with greater frequency at L5-S1. Modic type 2 changes are most common. Positive correlation exists between degenerative disk disease and modic changes.
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Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344(5):363- 70. https://doi.org/10.1056/ NEJM200102013440508
Albert HB, Kjaer P, Jensen TS, So¬rensen JS, Bendix T, Manniche C. Modic changes, possible causes and relation to low back pain. Med Hypoth¬eses. 2008;70(2):361-8. https://doi. org/10.1016/j.mehy.2007.05.014
Nguyen C, Bendeddouche I, Sanchez K, Jousse M, Papelard A, Feydy A,et al. As¬sessment of ankylosing spondylitis criteria in patients with chronic low back pain and vertebral endplate Modic I signal chang¬es. J Rheumatol. 2010;37(11):2334-9. https://doi.org/10.3899/jrheum.100165
Schistad EI, Espeland A, Rygh LJ, Roe C, Gjerstad J. The association between Modic changes and pain during 1-year follow-up in patients with lumbar radicu¬lar pain. Skeletal Radiol. 2014;43:1271- 9. https://doi.org/10.1007/s00256-014- 1928-0
Luoma K, Vehmas T, Kerttula L,Gron¬blad M, Rinne E. Chronic low back pain in relation to Modic changes, bony end¬plate lesions, and disc degeneration in a prospective MRI study. Eur Spine J. 2016;25(9):2873-81. https://doi. org/10.1007/s00586-016-4715-x.
Mok FP, Samartzis D, Karppinen J, Fong DY, Luk KD, Cheung KM. Modic chang¬es of the lumbar spine: prevalence, risk factors, and association with disc degeneration and low back pain in a large-scale population-based cohort. Spine J. 2016;16(1):32-41. https://doi. org/10.1016/j.spinee.2015.09.060
Modic MT, Masaryk TJ, Ross JS, Carter JR. Imaging of degenerative disk disease. Radiology. 1988;168:177-86. https: //doi. org/10.1148/radiology.168.1.3289089.
de Roos A, Kressel H, Spritzer C, Dalin¬ka M. MR imaging of marrow changes adjacent to end plates in degenerative lumbar disk disease. AJR Am J Roent¬genol 1987;149:531-4. https://doi. org/10.2214/ajr.149.3.531.
Modic MT, Steinberg PM, Ross JS, Ma¬saryk TJ, Carter JR. Degenerative disk disease: assessment of changes in ver¬tebral body marrow with MR imaging. Radiology. 1988;166:193-9. https://doi. org/10.1148/radiology.166.1.3336678.
Kuisma M, Karppinen J, Niinimaki J, Ojala R, Haapea M, Heliövaara M, et al. Modic changes in endplates of lumbar vertebral bodies: prevalence and asso¬ciation with low back and sciatic pain among middle-aged male workers. Spine (Phila Pa 1976). 2007;32:1116- 22. https://doi.org/10.1097/01. brs.0000261561.12944.ff.
Kuisma M, Karppinen J, Niinimaki J, Kurunlahti M, Haapea M, Vanharanta H, et al. A three-year follow-up of lum-bar spine endplate (Modic) changes. Spine (Phila Pa 1976). 2006;31:1714- 8. https://doi.org/10.1097/01. brs.0000224167.18483.14.
Hu ZJ, Zhao FD, Fang XQ, Fan SW. Modic changes, possible causes and promotion to lumbar intervertebral disc degenera¬tion. Med Hypotheses. 2009;73(6):930- 2. https://doi.org/10.1016/j. mehy.2009.06.038.
Jim JJ, Noponen-Hietala N, Cheung KM, Ott J, Karppinen J, Sahraravand A, et al. The TRP2 allele of COL9A2 is an age-dependent risk factor for the development and severity of in¬tervertebral disc degeneration. Spine (Phila Pa 1976). 2005;30(24):2735- 42. https://doi.org/10.1097/01. brs.0000190828.85331.ef.
Liuke, M, Solovieva S, Lamminen A, Luo¬ma K, Leino-Arjas P, Luukkonen R, et al. Disc degeneration of the lumbar spine in relation to overweight. Int J Obes (Lond). 2005;29(8):903-8. https://doi. org/10.1038/sj.ijo.0802974.
Frymoyer JW, Pope MH, Clements JH, Wilder DG, MacPherson B, Ashikaga T. Risk factors in low-back pain. An epi¬demiological survey. J Bone Joint Surg Am. 1983;65(2):213-8. https://doi. org/10.2106/00004623-198365020- 00010.
Svensson HO, Vedin A, Wilhelmsson C, Andersson GB. Low-back pain in relation to other diseases and cardio-vascular risk factors. Spine (Phila Pa 1976). 1983;8(3):277-85. https://doi. org/10.1097/00007632-198304000- 00008
Leboeuf-Yde C, Kjaer P, Bendix T, Man¬niche C. Self-reported hard physical work combined with heavy smoking or overweight may result in so-called Mod¬ic changes. BMC Musculoskelet Disord. 2008;9:5. https://doi.org/10.1186/1471- 2474-9-5
Albert HB, Manniche C. Modic chang¬es following lumbar disc herniation. Eur Spine J. 2007;16(7):977-82. https://doi. org/10.1007/s00586-007-0336-8
Jensen TS, Kjaer P, Korsholm L, Bendix T, Sorensen JS, Manniche C, et al. Pre¬dictors of new vertebral endplate signal (Modic) changes in the general popula¬tion. Eur Spine J. 2010;19(1):129-35. https://doi.org/10.1007/s00586-009- 1184-5
Kokkonen SM, Kurunlahti M, Tervonen O, Ilkko E, Vanharanta H. Endplate de¬generation observed on magnetic res¬onance imaging of the lumbar spine: correlation with pain provocation and disc changes observed on computed to¬mography diskography. Spine (Phila Pa 1976). 2002;27(20):2274-8. https://doi. org/10.1097/00007632-200210150- 00017
Chen Y, Bao J, Yan Q, Wu C, Yang H, Zou J. Distribution of Modic changes in patients with low back pain and its related fac¬tors. Eur J Med Res. 2019;24(1):34-42. https://doi.org/10.1186/s40001-019- 0393-6.
Blondel B, Tropiano P, Gaudart J, Huang RC, Marnay T. Clinical results of lumbar total disc arthroplasty in accordance with Modic signs, with a 2-year-mini¬mum follow-up. Spine (Phila Pa 1976). 2011;36(26):2309-15. https://doi. org/10.1097/BRS.0b013e31820f7372
Weishaupt D, Zanetti M, Hodler J, Boos N. MR imaging of the lumbar spine: preva¬lence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoar¬thritis of the facet joints in asymptomatic volunteers. Radiology. 1998;209(3):661- 6. https://doi.org/10.1148/radiolo-gy.209.3.9844656
Nasir H, Khan AU, Lala G, Azmat S. Fre¬quency of modic changes in degenerative disc disease on magnetic resonance im¬aging of lumbar spine. J Rawal Med Coll. 2016; 20(1):12-5.
Andersson GBJ. The epidemiology of spi¬nal disorders. In: Frymoyer JW, ed. The Adult Spine: Principles and Practice. 2nd ed. New York, NY: Raven Press; 1997. p.93–141.
Oyinloye OI, Bamidele JO, Popoola GO. Modic changes in adults with chronic low back pain in north central Nigeria. J West Afr Coll Surg. 2017;7(2):77-92.
Han C, Kuang M, Ma J, Ma X. Prevalence of modic changes in the lumbar verte¬brae and their association with workload, smoking and weight in Northern China. Scientific Reports. 2017;7:46341-8. https://doi.org/10.1038/srep46341.
Adams MA. Biomechanics of back pain. Acupunct Med. 2004;22(4):178-88. https://doi.org/10.1136/aim.22.4.178.
Liu J, Huang B, Hao L, Shan Z, Zhang X, Chen J et al. Association between Modic changes and endplate sclerosis: Evidence from a clinical radiology study and a rabbit model. J Orthop Translat. 2018;16:71-7. https://doi.org/10.1016/j. jot.2018.07.006.
Xu L, Chu B, Feng Y, Xu F, Zou YF. Modic changes in lumbar spine: prevalence and distribution patterns of end plate oede¬ma and end plate sclerosis. Br J Radiol. 2016;89(1060):20150650. https://doi. org/10.1259/bjr.20150650
Zhang YH, Zhao CQ, Jiang LS, Chen XD, Dai LY. Modic changes: a system¬atic review of the literature. Eur Spine J. 2008;17(10):1289-99. https://doi. org/10.1007/s00586-008-0758-y.