Original ArticleRadiologic Analysis of Kinematic Characteristics of Modic Changes Based on Lumbar Disc Degeneration Grade
Introduction
Modic changes (MCs) were first reported by Modic et al.1, 2 in the lumbar spine and were believed to be bone marrow or endplate changes visible on magnetic resonance images (MRI) of patients with degenerative disc disease. Generally, there are 3 different types of MCs with different typically changed MRI signals: MC I, II, and III. Sometimes, authors also consider a normal endplate as Modic type 0 or grade 0.2, 3 During the recent few decades, low back pain was widely agreed to be associated with MCs4, 5, 6, 7, 8; however, the potential mechanisms remained unclear. In fact, although most authors suggested that low back pain caused by MCs were attributed to endplate inflammation or infection,9, 10, 11, 12, 13, 14 several researchers proposed that there was a close relationship between MCs and segmental instability.15, 16 However, the motion characteristics of MCs in the lumbar spine were rarely reported, and the previous results only showed that MC I might be an unstable phase requiring spinal fusion, whereas MC II might indicate translational instability.5, 15, 16, 17, 18 Furthermore, considering that segmental motion was determined by both the intervertebral disc and the endplate, and MCs had a close relationship with disc degeneration (DD),5, 19, 20, 21 it is necessary to take DD into consideration in analyzing motion characteristics for the segments with MCs; Finally, because of the unequal effects of endplate and intervertebral disc on segmental motion,21 spine surgeons may have difficulty in determining segmental motion clinically for the segments with both advanced DD (such as grade E, indicating greatly reduced segmental motion) and early endplate degeneration (such as MC I, indicating segmental hypermotion). As a result, the purpose of this study is not only to comprehensively evaluate the motion differences between different types of MCs, but also to analyze the kinematic characteristics of MCs based on different DD grades.
Section snippets
Patient Population
Informed consent was obtained from all individual participants in the study, and the study was approved by the Ethical Committee of Huashan Hospital of Fudan University. Eight hundred ninety-four consecutive patients (495 men and 399 women) with slight back pain (visual analogue scale [VAS] 0–3) or tolerable low back pain (VAS 3–6) were reviewed The exclusion criteria were severe low back pain (VAS >7), trauma, infection, rheumatoid arthritis, spinal tumors, and history of lumbar spine surgery.
Prevalence of MCs
MCs were observed in 260 (29.08%) of 894 patients. Three hundred eight segments had MCs: type I in 57 segments, type II in 217 segments, and type III in 34 segments. Most of the MCs were found at L5/S1 (137), followed by L4/5 (97), L3/4 (44), L2/3 (19), and L1/2 (11).
There was no MC in segments with normal discs (DD grade A), and MC III was also not observed in segments with DD grade B. Also, several groups had relatively small numbers: B-MC I (13 segments), C-MC I (7 segments), D-MC I (9
Discussion
Inasmuch as segmental instability is a potential reason of low back pain in patients with MCs, a thorough understanding of the kinematic characteristics of MCs is necessary for improving doctor–patient communication and optimizing treatment selection. However, previous studies did not consider the effect of DD on segmental motion in analyzing the motion characteristics of MCs.5 As a matter of fact, there is a close relationship between DD and MC, and MCs are more likely to present in the
Conclusions
In conclusion, DD should be taken into consideration in analyzing the motion characteristics of segments with MCs. MC I and II may increase angular or translational motion in segments with advanced DD grades, which were previously believed to be stable. MC III may indicate a final stable phase, and there is no obvious difference in segmental motion between MC I and II.
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Conflict of interest statement: This study was supported by the National Natural Science Foundation of China (No. 81472036) to Feizhou Lu.
Fan Zhang, Hongli Wang, and Haocheng Xu contributed equally to this work.