Skip to main content

Advertisement

SpringerLink
Log in

Chronic low back pain in relation to Modic changes, bony endplate lesions, and disc degeneration in a prospective MRI study

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To clarify the significance of Modic changes, bony endplate lesions, and disc degeneration as predictors of chronic low back pain (LBP) during 1-year follow-up.

Methods

49 patients with severe, non-specific, chronic LBP, and Modic 1 lesion (M1) were prospectively studied with MRI and questionnaire. Changes in grade of disc degeneration, severity of Modic changes, Schmorl lesions, and bony endplate irregularities were evaluated and changes assessed in LBP intensity on numeric rating scale 0–10 and severity with Oswestry disability index 0–100 (ODI). Association between change in MRI findings and symptoms was computed using generalized estimating equations analysis.

Results

Although pain decreased in most patients during 1-year follow-up, it increased or persisted in 36 %. Change in M1, M2, bony endplate lesions, and signal intensity (SI) and height of the disc associated with change of pain intensity, while change in M1, bony endplate lesions, and disc height associated with change of ODI. Not only persistent M1s, increasing bony endplate lesions, decreasing disc height, and M2s, but also new M2s predicted persistence of pain, while decrease of M1s and SI of the disc and increase of size of M2s predicted decrease of pain. Changes in disc bulges did not associate with pain.

Conclusions

In patients with chronic non-specific LBP, persisting M1, decreasing disc height, and increasing bony endplate lesions associated with persisting pain while decrease of SI of the disc with decrease of pain. Such changing MRI findings in the same disc space have earlier been shown to progress abnormally fast. They may be signs or biomarkers of a prolonged pain causing, deforming degenerative process, and should lead to considering early intervention or specific treatments to affect that process.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Luoma K, Riihimäki H, Luukkonen R, Raininko R, Viikari-Juntura E, Lamminen A (2000) Low back pain in relation to lumbar disc degeneration. Spine 25(4):487–492

    Article  CAS  PubMed  Google Scholar 

  2. Endean A, Palmer KT, Coggon D (2011) Potential of magnetic resonance imaging findings to refine case definition for mechanical low back pain in epidemiological studies: a systematic review. Spine 36(2):160–169. doi:10.1097/BRS.0b013e3181cd9adb

    Article  PubMed  PubMed Central  Google Scholar 

  3. Steffens D, Hancock MJ, Maher CG et al (2014) Does magnetic resonance imaging predict future low back pain? A systematic review. Eur J Pain (England) 18(6):755–765. doi:10.1002/j.1532-2149.2013.00427

    Article  CAS  Google Scholar 

  4. Hebelka H, Brisby H, Hansson T (2014) Comparison between pain at discography and morphological disc changes at axial loaded MRI in patients with low back pain. Eur Spine J (Germany) 23(10):2075–2082. doi:10.1007/s00586-014-3408-6

    Article  Google Scholar 

  5. Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166:193–199

    Article  CAS  PubMed  Google Scholar 

  6. Kjaer P, Leboeuf-Yde C, Korsholm L, Sørensen JS, Bendix T (2005) Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year-old men and women. Spine 30:1173–1180

    Article  PubMed  Google Scholar 

  7. Jensen TS, Karppinen J, Sørensen JS, Niinimäki J, Leboeuf-Yde C (2008) Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J 17:1407–1422. doi:10.1007/s00586-008-0770-2

    Article  PubMed  PubMed Central  Google Scholar 

  8. Määttä JH, Wadge S, MacGregor A, Karppinen J, Williams FM (2015) ISSLS prize winner: vertebral endplate (Modic) change is an independent risk factor for episodes of severe and disabling low back pain. Spine 40(15):1187–1193. doi:10.1097/BRS.0000000000000937

    Article  PubMed  Google Scholar 

  9. Mok FP, Samartzis D, Karppinen J, Fong DY, Luk KD, Cheung KM (2016) Modic changes of the lumbar spine: prevalence, risk factors, and association with disc degeneration and low back pain in a large-scale population-based cohort. Spine 16(1):32–41. doi:10.1016/j.spinee.2015.09.060

    Article  Google Scholar 

  10. Kääpä E, Luoma K, Pitkäniemi J, Kerttula L, Grönblad M (2012) Correlation of size and type of modic type 1 and 2 lesion with clinical symptoms—a descriptive study in a subgroup of chronic low back pain patients based on a university hospital patient sample. Spine 37:134–139. doi:10.1097/BRS.0b013e3182188a90

    Article  PubMed  Google Scholar 

  11. Mitra D, Cassar-Pullicino VN, McCall IW (2004) Longitudinal study of vertebral type-1 end-plate changes on MR of the lumbar spine. Eur Radiol 14:1574–1581

    Article  CAS  PubMed  Google Scholar 

  12. Wang Y, Videman T, Battié MC (2012) ISSLS prize winner: lumbar vertebral endplate lesions: associations with disc degeneration and back pain history. Spine 37(17):1490–1496. doi:10.1097/BRS.0b013e3182608ac4

    Article  PubMed  Google Scholar 

  13. Luoma K, Vehmas T, Grönblad M, Kerttula L, Kääpä E (2008) MRI follow-up of subchondral signal abnormalities in a selected group of chronic low back pain patients. Eur Spine J 17:1300–1308. doi:10.1007/s00586-008-0716-8

    Article  PubMed  PubMed Central  Google Scholar 

  14. Luoma K, Vehmas T, Grönblad M, Kerttula L, Kääpä E (2009) Relationship of Modic type 1change with disc degeneration: a prospective MRI study. Skelet Radiol 38:237–244. doi:10.1007/s00256-008-0611-8

    Article  Google Scholar 

  15. Kerttula L, Luoma K, Vehmas T, Grönblad M, Kääpä E (2012) Modic type I change may predict rapid progressive, deforming disc degeneration: a prospective 1-year follow-up study. Eur Spine J 21:1135–1142. doi:10.1007/s00586-012-2147-9

    Article  PubMed  PubMed Central  Google Scholar 

  16. Fields AJ, Liebenberg EC, Lotz JC (2014) Innervation of pathologies in the lumbar vertebral end plate and intervertebral disc. Spine J 14(3):513–521. doi:10.1016/j.spinee.2013.06.075

    Article  PubMed  Google Scholar 

  17. Luoma K, Kerttula L, Vehmas T, Grönblad M (2014) Association of low-back pain with modic type endplate changes and disc degeneration using a detailed MRI-classification. Insights. Imaging 5(Suppl 1):S135–S136. doi:10.1007/s13244-014-0317-5 (Scientific paper) doi:10.1594/ecr2014/B-0458

    Google Scholar 

  18. Luoma K, Vehmas T, Raininko R, Luukkonen R, Riihimäki H (2004) Lumbosacral transitional vertebra: relation to disc degeneration and low back pain. Spine 29(2):200–205

    Article  PubMed  Google Scholar 

  19. Desmond PM, Buirski G (1993) Magnetic resonance appearances of developmental disc anomalies in the lumbar spine. Australas Radiol 37(1):26–29

    Article  CAS  PubMed  Google Scholar 

  20. Jensen RK, Leboeuf-Yde C, Wedderkopp N, Sørensen JS, Jensen TS, Manniche C (2012) Is the development of modic changes associated with clinical symptoms? A 14-month cohort study with MRI. Eur Spine J 21(11):2271–2279. doi:10.1007/s00586-012-2309-9

    Article  PubMed  PubMed Central  Google Scholar 

  21. Järvinen J, Karppinen J, Niinimäki J, Haapea M, Grönblad M, Luoma K, Kääpä E (2015) Association between changes in lumbar Modic changes and low back symptoms over a 2-year period. BMC Musculoskelet Disord 16:98. doi:10.1186/s12891-015-0540-3

    Article  PubMed  PubMed Central  Google Scholar 

  22. Peters CA, Vande Berg BC, Galand C, Lecouvet FE, Malghem J (2009) Fracture-associated and idiopathic subchondral vertebral lesions: a magnetic resonance study in autopsy specimens with histologic correlation. Skelet Radiol 38(3):245–253. doi:10.1007/s00256-008-0614-5

    Article  CAS  Google Scholar 

  23. Määttä JH, Karppinen JI, Luk KD, Cheung KM, Samartzis D (2015) Phenotype profiling of Modic changes of the lumbar spine and its association with other MRI phenotypes: a large-scale population-based study. Spine J 15(9):1933–1942. doi:10.1016/j.spinee.2015.06.056

    Article  PubMed  Google Scholar 

  24. Teraguchi M, Yoshimura N, Hashizume H, Muraki S, Yamada H, Oka H, Minamide A, Nakagawa H, Ishimoto Y, Nagata K, Kagotani R, Tanaka S, Kawaguchi H, Nakamura K, Akune T, Yoshida M (2015) The association of combination of disc degeneration, end plate signal change, and Schmorl node with low back pain in a large population study: the Wakayama Spine Study. Spine J 15(4):622–628. doi:10.1016/j.spinee.2014.11.012

    Article  PubMed  Google Scholar 

  25. Ohtori S, Inoue G, Ito T, Koshi T, Ozawa T, Doya H, Saito T, Moriya H, Takahashi K (2006) Tumor necrosis factor-immunoreactive cells and PGP 9.5-immunoreactive nerve fibers in vertebral endplates of patients with discogenic low back pain and Modic type 1 or type 2 changes on MRI. Spine 31:1026–1031

    Article  PubMed  Google Scholar 

  26. Yu SW, Haughton VM, Ho PS, Sether LA, Wagner M, Ho KC (1988) Progressive and regressive changes in the nucleus pulposus. Part II. The adult. Radiology 169(1):93–97

    Article  CAS  PubMed  Google Scholar 

  27. Albert HB, Sorensen JS, Christensen BS, Manniche C (2013) Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy. Eur Spine J (Germany) 22(4):697–707. doi:10.1007/s00586-013-2675-y

    Article  Google Scholar 

  28. Pfirmann C, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertabral disc degeneration. Spine 26(17):1873–1878

    Article  Google Scholar 

  29. De Schepper EI, Damen J, van Meurs JB, Ginai AZ, Popham M, Hofman A, Koes BW, Bierma-Zeinstra SM (2010) The association between lumbar disc degeneration and low back pain: the influence of age, gender, and individual radiographic features. Spine 35(5):531–536. doi:10.1097/BRS.0b013e3181aa5b33

    Article  PubMed  Google Scholar 

  30. Teichtahl AJ, Urquhart DM, Wang Y, Wluka AE, O’Sullivan R, Jones G, Cicuttini FM (2016) Modic changes in the lumbar spine and their association with body composition, fat distribution and intervertebral disc height—a 3.0 T-MRI study. BMC Musculoskelet Disord (England) 17(1):92. doi:10.1186/s12891-016-0934-x

    Article  Google Scholar 

Download references

Acknowledgments

Supported by Finska Läkaresällskapet.

Author information

Authors and Affiliations

  1. HUS Medical Imaging Center, Radiology, Meilahti Hospital, Helsinki and Uusimaa District University Hospital, P.O. Box 340, 00029, Hus, Helsinki, Finland

    Katariina Luoma

  2. Faculty of Medicine, Clinicum, University of Helsinki, Haartmaninkatu 8, 00014, Helsinki, Finland

    Katariina Luoma, Tapio Vehmas & Eeva Rinne

  3. Department of Occupational Medicine, Finnish Institute of Occupational Health, Topeliuksenkatu 41b, 00250, Helsinki, Finland

    Tapio Vehmas

  4. HUS-Medical Imaging Center, Radiology, Töölö Hospital, Helsinki and Uusimaa District University Hospital, Topeliuksenkatu 5, 00029, Hus, Helsinki, Finland

    Liisa Kerttula

  5. Department of Physical Treatment and Rehabilitation, Helsinki and Uusimaa District University Hospital, Peijas Hospital, P. O. Box 900, 00029, Hus, Helsinki, Finland

    Mats Grönblad

Authors
  1. Katariina Luoma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tapio Vehmas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Liisa Kerttula
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mats Grönblad
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eeva Rinne
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katariina Luoma.

Ethics declarations

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Luoma, K., Vehmas, T., Kerttula, L. et al. Chronic low back pain in relation to Modic changes, bony endplate lesions, and disc degeneration in a prospective MRI study. Eur Spine J 25, 2873–2881 (2016). https://doi.org/10.1007/s00586-016-4715-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-016-4715-x

Keywords

Search

Navigation