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Yiu K, Ahn H, Shea GKH. The effect of long-term alendronic acid treatment on Modic changes in the lumbar spine: a gender and age-matched study. J Orthop Surg Res 2024; 19:291. [PMID: 38735917 PMCID: PMC11089688 DOI: 10.1186/s13018-024-04780-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Low back pain (LBP) affects a significant proportion of the adult population. Potent anti-resorptive drugs such as intravenous zoledronic acid have been demonstrated to reduce Modic changes (MCs) upon magnetic resonance imaging (MRI) of the spine and concomitantly decrease associated LBP. It is uncertain whether oral alendronic acid has a similar effect. METHODS 82 subjects were recruited in this case-control study. Treatment subjects (n = 41) received oral alendronic acid treatment for at least 1-year and were matched by gender and age (± 2) to control subjects (n = 41) not receiving any anti-osteoporotic medication. The prevalence, type, and extent of MCs were quantified upon T1 and T2-weighted MRIs of the lumbosacral spine. RESULTS Treatment subjects received oral alendronic acid for 124.0 ± 62.1 weeks at the time of MRI assessment and exhibited a lower prevalence of MCs over the lumbosacral spine (18/41 vs. 30/41, p < 0.001) as compared to control subjects. Amongst both groups, type 2 MCs were predominant. Quantification of type 2 MCs in treatment subjects revealed a significant reduction in area (113 ± 106 mm2 vs. 231 ± 144 mm2, p < 0.01) and volume (453 ± 427 mm3 vs. 925 ± 575 mm3, p < 0.01) affected by type 2 MCs in comparison to matched controls. CONCLUSION Oral alendronic acid may be useful in the treatment of MC-associated LBP in patients with concomitant osteoporosis.
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Affiliation(s)
- Kenneth Yiu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Hyunjeong Ahn
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Graham Ka-Hon Shea
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
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Ji Z, Li J, Tao S, Li H, Kong X, Huang B, Feng Z, Wei X, Zheng Z, Chen J, Chen B, Liu J, Zhao F. Mrgprb2-mediated mast cell activation exacerbates Modic changes by regulating immune niches. Exp Mol Med 2024:10.1038/s12276-024-01230-1. [PMID: 38689089 DOI: 10.1038/s12276-024-01230-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/03/2023] [Accepted: 02/26/2024] [Indexed: 05/02/2024] Open
Abstract
Modic changes are radiographic features associated with microfracture, low-virulence organism infection and chronic inflammation with inflammatory cell infiltration in the vertebral endplate region. Mast cells, as innate immune cells similar to macrophages, are present in painful degenerated intervertebral discs. However, the involvement and mechanisms of mast cells in the development of Modic changes remain unclear. Herein, we found increased mast cell infiltration in samples from patients with Modic changes and in mouse models of Modic changes. To clarify the role of mast cells in the progression of Modic changes, we used mast cell-deficient (KITW-SH/W-SH) mice to construct a model of Modic changes and found that the severity of Modic changes in KITW-SH/W-SH mice was significantly lower than that in WT mice. These findings were further supported by the use of a mast cell-specific activator (compound 48/80) and a stabilizer (cromolyn). Furthermore, we found that mast cells were not activated via the classic IgE pathway in the Modic change models and that Mrgprb2 is the specific receptor for mast cell activation reported in recent studies. Then, we utilized Mrgprb2 knockout mice to demonstrate that Mrgprb2 knockout inhibited mast cell activation and thus reduced the degree of Modic changes. Transcriptomic sequencing revealed aberrant PI3K-AKT and MAPK pathway activation in the Mrgprb2-deficient mast cells. Additionally, Mrgpbrb2-activated mast cells regulate immune niches by recruiting macrophages, promoting M1 polarization and reducing M2 polarization, thereby promoting the progression of Modic changes. These findings suggest that mast cells may serve as a novel therapeutic target for addressing Modic changes.
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Affiliation(s)
- Zhongyin Ji
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China
- Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China
| | - Jie Li
- Department of Orthopaedic Surgery, Ningbo Medical Center Li Huili Hospital, Ningbo, Zhejiang, China
| | - Siyue Tao
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China
- Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China
| | - Hui Li
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China
- Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China
| | - Xiangxi Kong
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China
- Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China
| | - Bao Huang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China
- Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China
| | - Zhenhua Feng
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China
- Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China
| | - Xiaoan Wei
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China
- Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China
| | - Zeyu Zheng
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China
- Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China
| | - Jian Chen
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China
- Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China
| | - Binhui Chen
- Department of Orthopaedic Surgery, Ningbo Medical Center Li Huili Hospital, Ningbo, Zhejiang, China.
| | - Junhui Liu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China.
- Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China.
| | - Fengdong Zhao
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China.
- Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, No. 3, Qingchun Road East, Hangzhou, 310016, P. R. China.
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Li C, Gao W, Yao X, Tong T, Wang Y, Li W, Liu J, Zhou X, An J, Yu B, Wang L. The magnetic resonance imaging-based vertebral bone quality scoring system: A novel method to evaluate endplate changes in patients with primary single-level disk herniation and Modic changes. Jt Dis Relat Surg 2024; 35:257-266. [PMID: 38727103 PMCID: PMC11128952 DOI: 10.52312/jdrs.2024.1527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/27/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES This study aimed to investigate differences in vertebral fat distribution and bone density between patients with and without Modic changes (MCs) using a magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) scoring system. PATIENTS AND METHODS In this retrospective study, 189 patients (95 males, 94 females; mean age: 54±2.2 years; range, 18 to 82 years) with primary single-level disk herniation were reviewed between June 2021 and June 2022. The patients were divided into the MC group (n=99) and the non-MC (NMC) group (n=90). The subcutaneous fat tissue thickness and bone mineral density were determined. The system consisted of two scores: the VBQ score, which reflected the fatty infiltration within the vertebral body, and the endplate bone quality (EBQ) score, which reflected the signal intensity (SI) of the upper and lower endplates. The EBQ score is a novel measurement that we introduced in this study. The VBQ and EBQ were measured and scored using MRI scans. The mean SI of the upper and lower endplates (endplate SI)/the bone marrow SI (marrow SI) was measured. RESULTS There was a considerable difference in subcutaneous fat tissue thickness between the MC and NMC groups (1.40 vs. 1.16 cm, p=0.01). The EBQ scores of the L4 and L5 vertebrae and endplate SI/marrow SI of all vertebral body levels were significantly higher in the MC group. CONCLUSION The occurrence of MCs in the lumbar spine may be associated with abnormal fat distribution. The distribution of vertebral fat in patients with MCs is distributed earlier in the upper and lower endplates of the vertebral body, and this trend is not observed in patients without MC. The thickness of subcutaneous fat tissue is a key factor in the occurrence of MCs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Linfeng Wang
- The Third Hospital of Hebei Medical University 139 Ziqiang Street, Shijiazhuang 050051, Hebei, People's Republic of China.
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Li W, Djuric N, Cobbaert C, Vleggeert-Lankamp CLA. Modic Changes in the Lumbar Spine: Exploring Their Association with Abdominal Aortic Calcification as a Potential Indicator of Systemic Atherosclerosis. World Neurosurg 2024; 184:e503-e510. [PMID: 38310947 DOI: 10.1016/j.wneu.2024.01.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND This was a cross-sectional study on the correlation between abdominal aortic calcification (AAC) and Modic changes (MC). Little is known regarding the etiology of MC in the lumbar spine. Currently, insufficient vascularization of the endplate has been proposed to contribute to the appearance of MC. Our objective was to investigate whether AAC, a marker for a poor vascular status, is associated with MC in patients suffering from degenerative disc disease. METHODS Radiologic images of patients (n = 130) suffering from degenerative lumbar disc disease were reviewed. Type and severity of MC were assessed using magnetic resonance images, and severity of AAC was evaluated using computed tomography images or fluoroscopy. Both items were dichotomized into minimal and relevant grades. The correlation between them was studied using Spearman's correlation test, with age as a covariate. RESULTS Of the patients, 113 (87%) demonstrated MC (31% type I, 63% type II, and 6% type III) (55% relevant grade), and 68% had AAC (44% relevant grade). Spearman statistical analysis revealed that AAC was correlated with age (P < 0.001), whereas MC were not (P = 0.142). AAC severity was significantly correlated with MC, remaining so after age adjustment (P < 0.05). While MC type I lacked correlation with AAC, MC type II were significantly correlated with AAC (0.288, P = 0.015); however, this association lost significance after adjusting for age (P = 0.057). CONCLUSIONS AAC and MC (mainly MC type II) are associated, indicating that reduced blood supply or even a poor systemic vascularization status due to atherosclerotic disease may play a role in the formation of MC. Future studies focusing on the etiology of MC should pay more attention to patients' vascular status and determinants of abdominal aorta calcification.
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Affiliation(s)
- Wensen Li
- Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden, Netherlands.
| | - Niek Djuric
- Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden, Netherlands
| | - Christa Cobbaert
- Department of Clinical Chemistry, Leiden University Medical Center, Leiden, Netherlands
| | - Carmen L A Vleggeert-Lankamp
- Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden, Netherlands; Spaarne Gasthuis, Haarlem/Hoofddorp, Leiden, Netherlands
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Ardeshiri A, Amann M, Thomson S, Gilligan CJ. Application of restorative neurostimulation for chronic mechanical low back pain in an older population with 2-year follow up. Reg Anesth Pain Med 2024:rapm-2023-105032. [PMID: 38460963 DOI: 10.1136/rapm-2023-105032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/26/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION Data on the Medicare-aged population show that older patients are major consumers of low back pain (LBP) interventions. An effective approach for patients with mechanical LBP that has been refractory to conservative management is restorative neurostimulation. The efficacy of restorative neurostimulation has been demonstrated in multiple prospective studies, with published follow-up over 4 years, showing a consistent durable effect. METHODS To further examine the effect of restorative neurostimulation in an older demographic, data from three clinical studies were aggregated: ReActiv8-B prospectively followed 204 patients, ReActiv8-C study prospectively followed 87 patients and ReActiv8-PMCF prospectively followed 42 patients.Two hundred and sixty-one patients were identified with complete 2-year follow-up and divided into cohorts of equal size based of age quartiles.At 2 years from device activation, patients in either cohort were classified by change in disability (Oswestry Disability Index (ODI)) or change in pain score(NRS/VAS) and assessed as proportion of patients per group at each time point. Additionally, health-related quality of life (HRQoL) (EQ5D-5L) was longitudinally compared with baseline. Differences in proportions were assessed using χ2 and continuous variables by repeated measures analysis of variance. RESULTS The oldest quartile (n=65) had a median age of 60 (56-82) years compared with the entire population (n=261) who had a median age of 49 (22-82) years. The completer analysis on patients with 2 years of continuous data showed improvement of a 50% in pain was achieved by 62% and 65% and a 15-point ODI improvement in 48% and 60% in the oldest quartile and entire population, respectively. HRQoL (EuroQol 5-Dimension) improved from baselines of 0.568 and 0.544 to 0.763 and 0.769 in the oldest quartile and entire population respectively. All age quartiles improved statistically and clinically over baseline. CONCLUSIONS This aggregate analysis of three independent studies provides insight into the performance of restorative neurostimulation in an older population. Patients derived significant and clinically meaningful benefit in disability, pain and HRQoL. When compared with a similarly indicated cohort of younger patients, there were no statistically or clinically significant differences.
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Affiliation(s)
- Ardeshir Ardeshiri
- Department for Trauma Surgery and Orthopaedics, Klinikum Itzehoe, Itzahoe, Germany
| | - Marco Amann
- Orthopädisches Krankenhaus Schloss Werneck, Werneck, Germany
| | - Simon Thomson
- Pain and Neuromodulation, Mid and South Essex University NHSFT, Orsett Hospital, Essex, UK
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Gualdi F, Smith IG, Boixader RC, Williams FMK. Modic change is associated with increased BMI but not autoimmune diseases in TwinsUK. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3379-3386. [PMID: 37555954 DOI: 10.1007/s00586-023-07870-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/24/2023] [Accepted: 07/22/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE Low back pain (LBP) is one of the largest causes of morbidity worldwide. The aetiology of LBP is complex, and many factors contribute to the onset. Bone marrow lesions within the vertebra adjacent to an intervertebral degenerate disc named Modic change (MC) have been suggested as a diagnostic subgroup of LBP. Autoimmune response has been proposed to be one of the causes that promote the development of MC. The aim of the current investigation is to assess prevalence and severity of MC and LBP in participants with an autoimmune disease diagnosis in a well-documented cohort of adult twin volunteers. METHODS Multivariate generalized mixed linear models (GLMM) were implemented in order to calculate the association between having an autoimmune disorder and MC prevalence, width and severe and disabling LBP. The model was corrected for family structure as well as for covariates such as age, BMI and smoking. RESULTS No association was found between diagnosis of autoimmune disorder and MC. Interestingly, BMI was independently associated with MC width but not to MC prevalence. These results help to shed light on the relationship between MC and autoimmunity as well as the role of BMI in the development of the lesions. CONCLUSION This study is the first to examine autoimmune disorders and MC prevalence in a large, population-based female cohort. The study was well powered to detect a small effect. No association was found between having a diagnosis of one or more autoimmune conditions and MC prevalence, width or LBP.
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Affiliation(s)
- Francesco Gualdi
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Medical Research Institute (IMIM), Pompeu Fabra University (UPF), Barcelona, Spain.
- Structural Bioinformatics Lab (GRIB-IMIM), Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08005, Barcelona, Catalonia, Spain.
- Department Twin Research and Genetic Epidemiology, King's College London, St Thomas Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Isabelle Granville Smith
- Department Twin Research and Genetic Epidemiology, King's College London, St Thomas Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Roger Compte Boixader
- Department Twin Research and Genetic Epidemiology, King's College London, St Thomas Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Frances M K Williams
- Department Twin Research and Genetic Epidemiology, King's College London, St Thomas Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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Beukers M, Grinwis GCM, Vernooij JCM, van der Hoek L, Tellegen AR, Meij BP, Veraa S, Samartzis D, Tryfonidou MA, Bach FC. Epidemiology of Modic changes in dogs: Prevalence, possible risk factors, and association with spinal phenotypes. JOR Spine 2023; 6:e1273. [PMID: 37780831 PMCID: PMC10540828 DOI: 10.1002/jsp2.1273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/18/2023] [Accepted: 06/25/2023] [Indexed: 10/03/2023] Open
Abstract
Background Chronic low back pain, a leading contributor to disease burden worldwide, is often caused by intervertebral disc (IVD) degeneration. Modic changes (MCs) are MRI signal intensity changes due to lesions in vertebral bone marrow adjacent to degenerated IVDs. Only a few studies described the histopathological changes associated with MC to date. MC type 1 is suggested to be associated with bone marrow infiltration of fibrovascular tissue, type 2 with fatty infiltration, and type 3 with bone sclerosis in humans. Methods This study investigated whether the dog can be a valuable animal model to research MCs, by examining the prevalence, imaging, and histological characteristics of lumbar MCs in dogs (340 dogs, 2496 spinal segments). Results Logistic regression analysis indicated that the presence of lumbosacral MCs was associated with age and disc herniation (annulus fibrosis protrusion and/or nucleus pulposus extrusion). According to MRI analysis, MCs were mostly detected at the lumbosacral junction in dogs. Most signal intensity changes represented MC type 3, while previous spinal surgery seemed to predispose for the development of MC type 1 and 2. Histological analysis (16 dogs, 39 spinal segments) indicated that IVDs with MCs showed more histopathological abnormalities in the endplate and vertebral bone marrow than IVDs without MCs. Mostly chondroid proliferation in the bone marrow was encountered, while the histologic anomalies described in humans associated with MCs, such as fibrovascular or fatty infiltration, were scarcely detected. Conclusions Dogs spontaneously develop MCs, but may exhibit other pathological processes or more chronic bone marrow pathologies than humans with MCs. Therefore, more research is needed to determine the translatability of the MCs encountered in dog low-back-pain patients.
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Affiliation(s)
- Martijn Beukers
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Guy C. M. Grinwis
- Department of Biomolecular Health Sciences, Pathology Division, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Johannes C. M. Vernooij
- Department of Population Health Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Lisanne van der Hoek
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Anna R. Tellegen
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Björn P. Meij
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Stefanie Veraa
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush Medical CollegeRush University Medical CenterChicagoIllinoisUSA
| | - Marianna A. Tryfonidou
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Frances C. Bach
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
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Yuan L, Huang Z, Han W, Chang R, Sun B, Zhu M, Li C, Yan J, Liu B, Yin H, Ye W. The impact of dyslipidemia on lumbar intervertebral disc degeneration and vertebral endplate modic changes: a cross-sectional study of 1035 citizens in China. BMC Public Health 2023; 23:1302. [PMID: 37415123 PMCID: PMC10326938 DOI: 10.1186/s12889-023-16224-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Intervertebral disc degeneration (IDD) and vertebral endplate Modic changes (MCs) are common lumbar degenerative phenotypes related to low back pain (LBP). Dyslipidemia has been linked to LBP but its associations with IDD and MCs have not been fully elucidated. The present study aimed to address the possible link between dyslipidemia, IDD and MCs in the Chinese population. METHODS 1035 citizens were enrolled in the study. The levels of serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) were collected. IDD was evaluated based on the Pfirrmann grading system and subjects with an average grade ≥ 3 were defined as having degeneration. MCs were classified into typical types 1, 2 and 3. Covariables, including age, sex, BMI and fasting plasma glucose, were included for the adjustment of the logistic analyses. RESULTS The degeneration group included 446 subjects while the nondegeneration group included 589 subjects. The degeneration group had significant higher levels of TC and LDL-C (p < 0.001) whereas TG and HDL-C were not significantly different between the two groups. TC and LDL-C concentrations were significantly positively correlated with average IDD grades (p < 0.001). Multivariate logistic regression revealed that high TC (≥ 6.2 mmol/L, adjusted OR = 1.775, 95% CI = 1.209-2.606) and high LDL-C (≥ 4.1 mmol/L, adjusted OR = 1.818, 95% CI = 1.123-2.943) were independent risk factors for IDD. Type 1 MC presented in 84 (8.12%) subjects, type 2 MC presented in 244 (23.57%) subjects, type 3 MC presented in 27 (2.61%) subjects and no MC was observed in the remaining 680 (65.70%) subjects. The type 2 MC group demonstrated a higher level of TC, but the association between serum lipids and MCs could not be confirmed in further multivariate logistic regression. CONCLUSIONS High TC (≥ 6.2 mmol/L) and LDL-C (≥ 4.1 mmol/L) concentrations were independent risk factors for IDD for citizens in China. However, the association between dyslipidemia and MCs could not be determined. The effect of excess serum cholesterol may be critical for IDD and cholesterol lowering treatment may provide new opportunities in the management of lumbar disc degeneration.
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Affiliation(s)
- Liang Yuan
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhengqi Huang
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weitao Han
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruiming Chang
- Department of Health Examination Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bo Sun
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mingxi Zhu
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Spine Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Chenjing Li
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiansen Yan
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bin Liu
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haidong Yin
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
- Department of Minimally Invasive Spine Surgery, Panyu Hospital of Chinese Medicine, Guangzhou, China.
| | - Wei Ye
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Mayoral Rojals V, Amescua Garcia C, Denegri P, Narvaez Tamayo MA, Varrassi G. The Invasive Management of Pain: Diagnosis and New Treatment Options. Cureus 2023; 15:e42717. [PMID: 37654942 PMCID: PMC10466260 DOI: 10.7759/cureus.42717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 07/31/2023] [Indexed: 09/02/2023] Open
Abstract
Both the diagnosis and treatment of pain are evolving, especially in interventional approaches. Diagnosis of low back pain combines old and new methodologies, in particular, it involves an expanded role for ultrasound. While low back pain is a common complaint, there are many etiologies to the condition which must be explored before a final diagnosis can be made and treatment planned. Tumors and infections are rarely involved in low back pain but should be ruled out in the initial phase itself since failing to address them early can have devastating consequences. Some invasive treatments seem promising in the management of low back pain. Treating musculoskeletal pain with regenerative medicine, such as platelet-rich plasma, holds great promise. Autologous blood products are safe and may help stimulate the body's own responses for regeneration. The so-called "orthobiologics" play a role in sports medicine and the treatment of musculoskeletal pain. Neuromodulation, especially spinal cord stimulation, is undergoing a renaissance with new waveforms, devices, and a greater albeit incomplete understanding of its mechanisms of action. Spinal cord stimulation is not a first-line therapy and not all patients or all back problems respond to this treatment. Nevertheless, the therapy can be safe, effective, and cost-effective with appropriate patient selection. Radiofrequency ablation of nerves in the form of neurotomy can be effective in reducing the pain of osteoarthritis. These procedures, including the newer cooled radiofrequency neurotomy, can restore function, reduce pain, and may potentially have an opioid-sparing effect. Technical expertise in nerve and anatomy is needed for the use of this technique. This review article aims to provide updated information on some invasive intervention techniques in pain management.
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Affiliation(s)
| | | | - Pasquale Denegri
- Anesthesia, Intensive Care, and Pain Medicine, Sant'Anna and San Sebastiano Hospital, Caserta, ITA
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Shi Z, Li P, Wu W, Jiang Y, Wang Y. Analysis of the Efficacy of Percutaneous Endoscopic Interlaminar Discectomy for Lumbar Disc Herniation with Different Types/Grades of Modic Changes. J Pain Res 2023; 16:1927-1940. [PMID: 37303694 PMCID: PMC10257467 DOI: 10.2147/jpr.s403266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/27/2023] [Indexed: 06/13/2023] Open
Abstract
Background Percutaneous endoscopic interlaminar discectomy (PEID), one of the main techniques of spinal endoscopy, has achieved excellent results in treating lumbar disc herniation (LDH). However, its efficacy has not been systematically described in patients with LDH accompanied by Modic changes (MC). Purpose The purpose of this study was to observe the clinical efficacy of PEID treatment of LDH accompanied by MC. Patients and Methods A total of 207 patients who underwent PEID surgery for LDH were selected. According to the existence and type of MC on preoperative lumbar magnetic resonance images (MRI), they were divided into normal group (no MC, n=117), M1 group (MC I, n=23), and M2 group (MC II, n=67). According to the severity of MC, they were divided into MA group (grade A, n=45) and MBC group (grade B and C, n=45). The visual analog scale (VAS) score, Oswestry disability index (ODI) score, Disc height index (DHI), Lumbar lordosis angle (LL) and modified Macnab criteria were used to assess clinical outcomes. Results Postoperative back pain and leg pain VAS scores and ODI scores were significantly improved in all groups compared with preoperative scores. Patients with MC showed a deterioration in postoperative back pain VAS scores and ODI scores as time went by, and postoperative DHI decreased significantly compared with preoperative. Postoperative LL did not change significantly in each group. There was no significant difference in complications, recurrence rate and excellent rate between the groups. Conclusion Whether accompanied by MC or not, the efficacy of PEID for LDH was significant. However, postoperative back pain and functional status of patients with MC tend to deteriorate as time went by, especially those with type I or severe MC.
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Affiliation(s)
- Zhen Shi
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
| | - Pengfei Li
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
| | - Wentao Wu
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
| | - Yunduo Jiang
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
| | - Yansong Wang
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
- NHC Key Laboratory of Cell Transplantation, Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
- Heilongjiang Provincial Key Laboratory of Hard Tissue Development and Regeneration, Harbin Medical University, Harbin, Heilongjiang Province, People’s Republic of China
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11
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Czaplewski LG, Rimmer O, McHale D, Laslett M. Modic changes as seen on MRI are associated with nonspecific chronic lower back pain and disability. J Orthop Surg Res 2023; 18:351. [PMID: 37170132 PMCID: PMC10176889 DOI: 10.1186/s13018-023-03839-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/07/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Estimating the contribution of endplate oedema known as Modic changes to lower back pain (LBP) has been the subject of multiple observational studies and reviews, some of which conclude that the evidence for an association of Modic change with LBP is uncertain while others demonstrate a clear link. The clinical trials demonstrating the benefit of basivertebral nerve ablation, a therapeutic intervention, in a tightly defined homogenous patient group with chronic LBP and Modic changes type 1 or type 2, provides further evidence for the contribution of Modic changes to LBP and shows that in these subjects, nerve ablation substantially reduces pain and disability. These interventional studies provide direct evidence that Modic changes can be associated with lower back pain and disability. This review set out to explore why the literature to date has been conflicting. METHODS A narrative, forensic, non-systematic literature review of selected articles to investigate why the published literature investigating the association between Modic imaging changes and chronic low back pain is inconsistent. RESULTS This review found that previous systematic reviews and meta-analyses included both heterogeneous study designs and diverse patient syndromes resulting in an inconsistent association between Modic changes and nonspecific chronic lower back pain. Re-analysis of literature data focussing on more homogenous patient populations provides clearer evidence that Modic changes are associated with nonspecific chronic lower back pain and that type 1 Modic changes are more painful than type 2. CONCLUSIONS Studies using tightly defined homogenous patient groups may provide the best test for association between MRI-findings and pain and disability. Clinical benefit of basivertebral nerve ablation observed in randomised controlled trials further supports the association between type 1 and type 2 Modic changes with pain and disability.
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Affiliation(s)
- Lloyd G Czaplewski
- Persica Pharmaceuticals Ltd, 7 Denne Hill Business Centre, Womenswold, Canterbury, Kent, CT4 6HD, UK.
| | - Otis Rimmer
- Veramed Ltd, 5th Floor Regal House, 70 London Road, Twickenham, TW1 3QS, UK
| | | | - Mark Laslett
- Mark Laslett, Physiotherapy Specialist, The Sports Clinic, 156 Bealey Ave., Christchurch, 8014, New Zealand
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Sherwood D, Haring RS, Schirmer D, Modic M. The interrater reliability of Modic changes among a potential basivertebral nerve ablation population: Why AC1 may be preferred to kappa. J Orthop Res 2022; 41:1123-1130. [PMID: 36200411 DOI: 10.1002/jor.25449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/30/2022] [Accepted: 10/01/2022] [Indexed: 02/04/2023]
Abstract
Interrater reliability of Modic changes is subject to variables which affect consistency in reporting. Given the importance of Modic change identification for basivertebral nerve ablation (BVNA) candidacy, interrater reliability for this specific cohort has not yet been reported. Twenty lumbar magnetic resonance images of potential basivertebral nerve candidates were independently reviewed by two neuroradiologists and two interventional spine physiatrists for the presence and characterization of Modic changes. The kappa value of their agreement on the presence of Modic changes was 0.52 (95% confidence interval [CI] 0.37-0.67), whereas agreement on the type of Modic change was 0.51 (95% CI 0.37-0.65). Using an alternative methodology for measuring interrater reliability (Gwet's AC1) yielded the identification of the presence of Modic changes at AC1 0.51 (95% CI 0.36-0.66), whereas agreement on the type of Modic change was AC1 0.75 (95% CI 0.66-0.83). While less common, AC1 may be preferred in the appropriate cohort to kappa as it mitigates some of the pitfalls to which kappa values may be victim. Ultimately, our results are in-line with previous reports of interrater reliability results for Modic changes in other cohorts and should serve to caution those who perform BVNA regarding interrater agreement of the imaging crux of the procedure.
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Affiliation(s)
- David Sherwood
- Department of Orthopedics, University Health Lakewood Medical Center, Kansas City, Missouri, USA
| | - Richard Sterling Haring
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Derek Schirmer
- Stanford University Medical Center, Physical Medicine and Rehabilitation Division, Redwood City, California, USA
| | - Michael Modic
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Sherwood D, Miller S, Epps A, Gill B, Zhivotenko O, Khan S, Swenson T, Gardner J, Roehmer C, Martin D, Kennedy DDJ, Modic M, Schneider BJ. A First Estimate of the Annual Prevalence of Basivertebral Nerve Ablation Candidates in a Spine Clinic. PAIN MEDICINE 2022; 23:1858-1862. [PMID: 35652735 DOI: 10.1093/pm/pnac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/29/2022] [Accepted: 05/19/2022] [Indexed: 11/14/2022]
Abstract
Emerging literature purports the use of basivertebral nerve ablation (BVNA) for a specific cohort of patients with chronic low back pain and Type 1 or Type 2 Modic changes from vertebral levels L3-S1. The early literature warrants further evaluation. Studies establishing the efficacy of BVNA use highly selective patient criteria. The population which fulfills these criteria in our practice is small. Our study suggests it is perhaps 3% (11/338, 95% CI 1-5%).
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Affiliation(s)
- David Sherwood
- University Health-Lakewood Medical Center. Department of Orthopedics. 7900 Lee's Summit Rd, Kansas City, MO, 64139. USA
| | - Scott Miller
- Vanderbilt University Medical Center. Department of Physical Medicine and Rehabilitation. 2201 Children's Way, Suite 1318, Nashville, TN, 37212. USA
| | - Adam Epps
- Vanderbilt University Medical Center. Department of Physical Medicine and Rehabilitation. 2201 Children's Way, Suite 1318, Nashville, TN, 37212. USA
| | - Benjamin Gill
- University of Missouri, Columbia. Department of Physical Medicine and Rehabilitation. 1 Hospital Drive DC046.00, Columbia, MO, 65212. USA
| | - Oksana Zhivotenko
- Orthopedic Partners. Department of Physical Medicine and Rehabilitation. 82 New Park Ave, North Franklin, CT, 06254. USA
| | - Samir Khan
- Vanderbilt University Medical Center. Department of Physical Medicine and Rehabilitation. 2201 Children's Way, Suite 1318, Nashville, TN, 37212. USA
| | - Theodora Swenson
- Vanderbilt University Medical Center. Department of Physical Medicine and Rehabilitation. 2201 Children's Way, Suite 1318, Nashville, TN, 37212. USA
| | - James Gardner
- Vanderbilt University Medical Center. Department of Physical Medicine and Rehabilitation. 2201 Children's Way, Suite 1318, Nashville, TN, 37212. USA
| | - Christian Roehmer
- Vanderbilt University Medical Center. Department of Physical Medicine and Rehabilitation. 2201 Children's Way, Suite 1318, Nashville, TN, 37212. USA
| | - Dann Martin
- Vanderbilt University Medical Center. Department of Radiology. 1211 Medical Center Drive, Nashville, TN, 37232. USA
| | - David D J Kennedy
- Vanderbilt University Medical Center. Department of Physical Medicine and Rehabilitation. 2201 Children's Way, Suite 1318, Nashville, TN, 37212. USA
| | - Michael Modic
- Vanderbilt University Medical Center. Department of Radiology. 1211 Medical Center Drive, Nashville, TN, 37232. USA
| | - Byron J Schneider
- Vanderbilt University Medical Center. Department of Physical Medicine and Rehabilitation. 2201 Children's Way, Suite 1318, Nashville, TN, 37212. USA
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Illeez OG, Bahadir Ulger FE, Aktas I. The effect of transitional vertebrae and spina bifida occulta on disc herniation, disc degeneration, and end-plate changes in pediatric patients with low back pain. Acta Orthop Belg 2022; 88:275-283. [DOI: 10.52628/88.2.8528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of the study is to investigate the assumption whether lumbosacral transitional vertebrae (LSTV) and spina bifida occulta (SBO) cause lumbar disc herniation (LDH), intervertebral disc degeneration (IDD), and vertebral endplate changes / Modic changes (MCs) in children and adolescents with low back pain (LBP). Four hundred patients (aged 10-17) with LBP persisting for at least six weeks were included in the study. Lumbosacral X-rays were examined for the presence of LSTV and SBO. The prevalence of IDD/MCs and LDH at L4-5 and L5-S1 levels were investigated by evaluating the lumbosacral MRI of the patients with and without LSTV-SBO. The study population consisted of 219 girls and 181 boys with mean age 14.9±1.9. LSTV was determined in 67 (16.8%) patients and SBO in 62 (15.5%). No significant difference was observed in the prevalence of IDD, MCs, and LDH in patients with and without LSTV/SBO. LSTV and SBO were not observed in approximately 80% of patients without LDH and IDD/MCs. The presence of LSTV and SBO does not appear to represent a risk factor for early degeneration in lumbar spine and LDH in children and adolescents with LBP.
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Distribution Patterns of Degeneration of the Lumbar Spine in a Cohort of 200 Patients with an Indication for Lumbar MRI. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063721. [PMID: 35329406 PMCID: PMC8951543 DOI: 10.3390/ijerph19063721] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/16/2022] [Accepted: 03/19/2022] [Indexed: 11/29/2022]
Abstract
Lower back pain is one of the most common causes of a reduced quality of life. Magnetic resonance imaging (MRI) is the best suited imaging technique to detect causes of that pain. We retrospectively evaluated the MRIs of the lumbar spine for 200 patients in order to describe the distribution of signs of degeneration with regard to age, sex, and position of the disc affected. The number of spinal segments affected by degeneration increased with age, as did the number of signs of degeneration per segment. In patients aged between 21 and 30, 38.8% of discs were affected, while for patients aged between 51 and 60, 91.6% of discs were affected. There was no statistically significant gender difference. The lower two segments were most commonly affected by degeneration. The most common were structural changes to the discs, which affected 88.4% of patients over 50. Spondylosis was the most common bone-related change, found in 60.4% of patients over the age of 50. A reduction in disc height increases the likelihood of structural changes to the disc and bone-related changes. When investigating risk factors for developing disc-related diseases, the complex disc degeneration patterns described here should be taken into account.
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16
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Endplate defects, not the severity of spinal stenosis, contribute to low back pain in patients with lumbar spinal stenosis. Spine J 2022; 22:370-378. [PMID: 34600109 DOI: 10.1016/j.spinee.2021.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/10/2021] [Accepted: 09/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND CONTEXT It is controversial whether lumbar spinal stenosis (LSS) itself contributes to low back pain (LBP). Lower truncal skeletal muscle mass, spinopelvic malalignment, intervertebral disc degeneration, and endplate abnormalities are thought to be related to LBP. However, whether these factors cause LBP in patients with LSS is unclear. PURPOSE To identify factors associated with LBP in patients with LSS. STUDY DESIGN/SETTING Cross-sectional design. PATIENT SAMPLE A total of 260 patients (119 men and 141 women, average age 72.8 years) with neurogenic claudication caused by LSS, as confirmed by magnetic resonance imaging (MRI). OUTCOME MEASURES Ratings of LBP, buttock and leg pain, and numbness on a numerical rating scale (NRS), 36-Item Short Form Survey (SF-36) scores, muscle mass measured by bioelectrical impedance analysis, and radiographic measurements including slippage and lumbopelvic alignment. The severity of LSS, endplate defects, Modic endplate changes, intervertebral disc degeneration, and facet joint osteoarthritis were assessed on MRI. METHODS The presence of LBP was defined as an NRS score ≥3. The demographic data, patient-reported outcomes, and radiological and MRI findings were compared between patients with and without LBP. Multivariate logistic regression analysis was used to identify the factors that were independently associated with the presence of LBP. RESULTS There were significant differences between patients with and without LBP for buttock and leg pain and numbness on the NRS, general health on the SF-36, presence of endplate defects, presence of Modic changes, disc degeneration grading, and disc height grading (all p < .05). Multivariate logistic regression analysis showed significant associations between LBP and diabetes (OR 2.43; 95% CI 1.07-5.53), buttock and leg numbness on the NRS (OR 1.34; 95% CI 1.17-1.52), general health on the SF-36 (OR 0.97; 95% CI 0.95-0.99), and the presence of erosive endplate defects (OR 3.04; 95% CI 1.51-6.11) (all p < .05). CONCLUSIONS These results suggest that LBP in patients with LSS should be carefully assessed not only for spinal stenosis but also clinical factors and endplate defects.
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Ekşi MŞ, Orhun Ö, Yaşar AH, Dursun AT, Berikol G, Börekci A, Özcan-Ekşi EE. At What Speed Does Spinal Degeneration Gear Up?: Aging Paradigm in Patients with Low Back Pain. Clin Neurol Neurosurg 2022; 215:107187. [DOI: 10.1016/j.clineuro.2022.107187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 11/25/2022]
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18
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Karaca R, Kacar E, Gunduz D, Korfali E. Vertebral end-plate changes: Are they clinically significant for postoperative low back pain? WEST AFRICAN JOURNAL OF RADIOLOGY 2022. [DOI: 10.4103/wajr.wajr_31_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Özcan-Ekşi EE, Turgut VU, Küçüksüleymanoğlu D, Ekşi MŞ. Obesity could be associated with poor paraspinal muscle quality at upper lumbar levels and degenerated spine at lower lumbar levels: Is this a domino effect? J Clin Neurosci 2021; 94:120-127. [PMID: 34863425 DOI: 10.1016/j.jocn.2021.10.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/15/2021] [Accepted: 10/04/2021] [Indexed: 12/26/2022]
Abstract
Vertebral end-plate changes and paraspinal muscles are recently getting much more attention, since they could be associated with intervertebral disc degeneration (IVDD) and low back pain (LBP). Even though obesity is known as a risk factor for LBP, the role of obesity in the process of LBP is still controversial. In this study, we aimed to identify whether increased body mass index (BMI) was associated with IVDD, vertebral end-plate changes and paraspinal muscle quality. Consecutive women and men, aged between 20 and 50 years, presented with chronic LBP to the outpatient clinics were included. Patients were evaluated in terms of IVDD, vertebral end-plate changes, fatty infiltration in the paraspinal muscles at all lumbar levels on magnetic resonance imaging. Severe IVDD was more common in obese patients than in non-obese patients (73.5% vs. 50.4%, p = 0.017). When we compared the groups level by level, the significant difference for severe IVDD was present only at L4-L5 disc level (50% vs. 27.4%, p = 0.013). There was a higher trend of harboring Modic change at any lumbar level in obese patients, significantly in women (35.9% vs. 16.4%, p = 0.026). More severe fatty infiltration in the paraspinal muscles was seen at upper lumbar levels of the obese patients, particularly in women. Patients with higher BMI and suffering from LBP, had more fatty infiltration in the paraspinal muscles at the upper lumbar levels, more severe IVDD, and Modic changes at the lower lumbar levels; particularly women.
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Affiliation(s)
- Emel Ece Özcan-Ekşi
- Bahçeşehir University, School of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
| | - Veli Umut Turgut
- Antalya Atatürk State Hospital, Neurosurgery Clinic, Antalya, Turkey
| | | | - Murat Şakir Ekşi
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey.
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Braun J, Landewé RB. Response to: Correspondence on 'No efficacy of anti-IL-23 therapy for axial spondyloarthritis in randomised controlled trials but in post-hoc analyses of psoriatic arthritis-related 'physicianreported spondylitis'?' by Braun and Landewe. Ann Rheum Dis 2021:annrheumdis-2021-221816. [PMID: 34844931 DOI: 10.1136/annrheumdis-2021-221816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Juergen Braun
- Rheumazentrum Ruhrgebiet, Ruhr Universität Bochum, Herne, NRW, Germany
| | - Robert Bm Landewé
- Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands.,Rheumatology, Zuyderland MC, Heerlen, The Netherlands
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Teraguchi M, Hashizume H, Oka H, Cheung JPY, Samartzis D, Tamai H, Muraki S, Akune T, Tanaka S, Yoshida M, Yoshimura N, Yamada H. Detailed Subphenotyping of Lumbar Modic Changes and Their Association with Low Back Pain in a Large Population-Based Study: The Wakayama Spine Study. Pain Ther 2021; 11:57-71. [PMID: 34782999 PMCID: PMC8861214 DOI: 10.1007/s40122-021-00337-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/22/2021] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION To examine the association between the five types of Modic changes and low back pain (LBP) in a large population-based cohort. METHODS Of the 952 participants in the second Wakayama Spine Study, 814 (men, 246; women, 568; mean age, 63.6 years) were included in this study. Endplate changes on magnetic resonance imaging were classified according to the Modic classification system. Low back pain (LBP) was defined as continuous back pain for at least 48 h in the past month that is currently present. The prevalence of Modic changes in the lumbar region was assessed. Multivariate logistic regression analysis was conducted to determine the association between detailed subphenotype of Modic change and LBP comparing no Modic change in the lumbar spine and each level, respectively. RESULTS Modic changes throughout the lumbar spine were noted in 63.5% (n = 516) of all participants, with types I, I/II, II, II/III, and III observed in 7.8% (n = 63), 10.8% (n = 88), 40.0% (n = 326), 2.1% (n = 17), and 2.7% (n = 22), respectively. Modic types I/II were associated with LBP [odds ratio (OR): 3.26; 95% confidence interval (CI) 1.9, 5.5]. Furthermore, Modic type I/II changes at L2/3 and L4/5 were significantly associated with LBP (odds ratio: 2.77; 95% CI 1.04, 7.39 at L2/3; odds ratio: 2.86; 95% CI 1.39, 5.90 at L4/5). CONCLUSIONS Type I/II Modic changes in the lumbar region are significantly associated with LBP. To the best of our knowledge, this is the first large population-based study on the association between various Modic changes and LBP.
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Affiliation(s)
- Masatoshi Teraguchi
- Department of Orthopaedic Surgery, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi Town, Ito, Wakayama, Japan.
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, Faculty of Medicine, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Jason P Y Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Hidenobu Tamai
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Shigeyuki Muraki
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Toru Akune
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
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Abdollah V, Parent EC, Dolatabadi S, Marr E, Croutze R, Wachowicz K, Kawchuk G. Texture analysis in the classification of T 2 -weighted magnetic resonance images in persons with and without low back pain. J Orthop Res 2021; 39:2187-2196. [PMID: 33247597 DOI: 10.1002/jor.24930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/30/2020] [Accepted: 11/25/2020] [Indexed: 02/04/2023]
Abstract
Magnetic resonance imaging findings often do not distinguish between people with and without low back pain (LBP). However, there are still a large number of people who undergo magnetic resonance imaging to help determine the etiology of their back pain. Texture analysis shows promise for the classification of tissues that look similar, and machine learning can minimize the number of comparisons. This study aimed to determine if texture features from lumbar spine magnetic resonance imaging differ between people with and without LBP. In total, 14 participants with chronic LBP were matched for age, weight, and gender with 14 healthy volunteers. A custom texture analysis software was used to construct a gray-level co-occurrence matrix with one to four pixels offset in 0° direction for the disc and superior and inferior endplate regions. The Random Forests Algorithm was used to select the most promising classifiers. The linear mixed-effect model analysis was used to compare groups (pain vs. pain-free) at each level controlling for age. The Random Forest Algorithm recommended focusing on intervertebral discs and endplate zones at L4-5 and L5-S1. Differences were observed between groups for L5-S1 superior endplate contrast, homogeneity, and energy (p = .02). Differences were observed for L5-S1 disc contrast and homogeneity (p < .01), as well as for the inferior endplates contrast, homogeneity, and energy (p < .03). Magnetic resonance imaging textural features may have potential in identifying structures that may be the target of further investigations about the reasons for LBP.
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Affiliation(s)
- Vahid Abdollah
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Eric C Parent
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Samin Dolatabadi
- Department of Biological Sciences, Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Erica Marr
- Department of Biological Sciences, Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Roger Croutze
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Keith Wachowicz
- Department of Oncology, Medical Physics Division, University of Alberta, Edmonton, Alberta, Canada.,Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Greg Kawchuk
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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23
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Chung NS, Lee HD, Jeon CH. The Impact of Vertebral End Plate Lesions on the Radiological Outcome in Oblique Lateral Interbody Fusion. Global Spine J 2021; 11:1176-1182. [PMID: 32744116 PMCID: PMC8453684 DOI: 10.1177/2192568220941447] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVES Vertebral end plate (EP) lesions include Modic changes, Schmorl's nodes, EP erosion, EP sclerosis, and so on. While previous studies have mostly focused on the association between vertebral EP lesions and low back pain, few studies evaluated the influence of vertebral EP lesions on the radiological outcomes in lumbar interbody fusion. METHODS This study included a total of 125 operated disc levels from 86 consecutive patients who underwent a 1- or 2-level oblique lateral interbody fusion (OLIF) and had more than 1-year regular follow-up. The presence of vertebral EP lesions, changes in disc heights/angle, cage subsidence, and fusion grade were examined. The associations between vertebral EP lesions and radiological parameters were analyzed. RESULT The presence of Modic changes, Schmorl's node, EP cartilage erosion, and EP sclerosis were found in 72 (57.6%), 26 (20.8%), 31 (24.8%), and 44 (35.2%) disc levels, respectively. The mean anterior disc height increased from 6.9 ± 3.8 mm to 13.1 ± 2.7 mm (P < .001) and the mean segmental angle increased from 2.9° ± 5.8° to 9.2° ± 4.8° (P < .001) at the last follow-up. The overall fusion rate was 98.4% (123/125) and cage subsidence rate was 7.2% (9/125). All radiological parameters and cage subsidence rate were not different regardless of vertebral EP lesions. CONCLUSIONS Vertebral EP lesions did not affect the overall radiological outcome in 1- or 2-level OLIF. These results come from the stable contact between lateral cage and peripheral rim of vertebral EP.
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Affiliation(s)
- Nam-Su Chung
- Ajou University School of Medicine, Suwon, South Korea
| | - Han-Dong Lee
- Ajou University School of Medicine, Suwon, South Korea
| | - Chang-Hoon Jeon
- Ajou University School of Medicine, Suwon, South Korea,Chang-Hoon Jeon, Department of Orthopaedic Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, Geyounggi-do, 16499, South Korea.
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24
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Liu C, Abdel Shaheed C, Braten LC, Hancock MJ, Underwood M, Jarvik JG, Elliott J, Maher CG, Buchbinder R, Lin CWC. Antibiotic treatment for low back pain or radicular pain, or both. Hippokratia 2021. [DOI: 10.1002/14651858.cd014221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Chang Liu
- Institute for Musculoskeletal Health; The University of Sydney and Sydney Local Health District; Sydney Australia
- School of Public Health; Faculty of Medicine and Health, The University of Sydney; Sydney Australia
| | - Christina Abdel Shaheed
- Institute for Musculoskeletal Health; The University of Sydney and Sydney Local Health District; Sydney Australia
- School of Public Health; Faculty of Medicine and Health, The University of Sydney; Sydney Australia
| | - Lars Christian Braten
- Research and Communication Unit for Musculoskeletal Health (FORMI); Oslo University Hospital; Oslo Norway
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology; Cabrini Health; Melbourne Australia
| | - Mark J Hancock
- Faculty of Medicine, Health and Human Sciences; Macquarie University; Sydney Australia
| | - Martin Underwood
- Warwick Clinical Trials Unit; University of Warwick; Coventry UK
| | - Jeffrey G Jarvik
- Radiology and Neurological Surgery, Clinical Learning, Evidence And Research (CLEAR) Center; University of Washington School of Medicine; Seattle USA
| | - Julian Elliott
- Cochrane Australia; School of Public Health & Preventive Medicine; Melbourne Australia
| | - Christopher G Maher
- Institute for Musculoskeletal Health; The University of Sydney and Sydney Local Health District; Sydney Australia
- School of Public Health; Faculty of Medicine and Health, The University of Sydney; Sydney Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology; Cabrini Health; Melbourne Australia
| | - Chung-Wei Christine Lin
- Institute for Musculoskeletal Health; The University of Sydney and Sydney Local Health District; Sydney Australia
- School of Public Health; Faculty of Medicine and Health, The University of Sydney; Sydney Australia
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25
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Zhu J, Wu H, Chen Y, Liu J, Shan Z, Fan S, Zhao F. The correlation between the change of Hounsfield units value and Modic changes in the lumbar vertebral endplate. BMC Musculoskelet Disord 2021; 22:509. [PMID: 34078344 PMCID: PMC8173826 DOI: 10.1186/s12891-021-04330-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/05/2021] [Indexed: 12/05/2022] Open
Abstract
Objectives To evaluate the changes of Hounsfield units (HU) value in different types of Modic changes (MCs) and to analyze the correlation between the change of HU value and area ratio of MCs region, bone mineral density (BMD), and degree of intervertebral disc degeneration. Methods One hundred fifty-eight endplates with MCs were included and analyzed. HU values of MCs regions and adjacent vertebral corresponding regions without MCs were measured. The area ratio of MCs region was defined as the area of MCs divided by the area of endplate or the vertebral sagittal plane. BMD was measured by Dual-energy x-ray absorptiometry (DXA). Degree of intervertebral disc degeneration was evaluated based on Pfirrmann classification. According to the types of variables, descriptive statistics, Kolmogorove-Smirnov test, paired t-test, Wilcoxon signed-rank test, Independent-Samples T Test, and Pearson correlation analysis were used. Results The HU values in any types of MCs are significantly higher than that of adjacent vertebral corresponding regions without MCs (P < 0.001). The HU value of the type III MCs is higher than that of the type I and type II MCs. HU value was positively correlated with BMD. In the levels with Grade V disc degeneration, the area ratio of MCs region was significant increased. Conclusions HU values of the vertebral endplate and bone marrow were increased in most MCs regions with all types of MCs. HU value of endplates had a significantly positive correlation with BMD. Higher area ratio of MCs region is associated with more severe intervertebral disc degeneration.
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Affiliation(s)
- Jiandong Zhu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun Rd East, Hangzhou, 310016, China.,Tongxiang first people's Hospital, Tongxiang, China.,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, China
| | - Hao Wu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China
| | - Yilei Chen
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun Rd East, Hangzhou, 310016, China.,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, China
| | - Junhui Liu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun Rd East, Hangzhou, 310016, China.,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, China
| | - Zhi Shan
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun Rd East, Hangzhou, 310016, China.,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, China
| | - Shunwu Fan
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun Rd East, Hangzhou, 310016, China.,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, China
| | - Fengdong Zhao
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun Rd East, Hangzhou, 310016, China. .,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, China.
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26
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The association between vertebral endplate structural defects and back pain: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2531-2548. [PMID: 34021785 DOI: 10.1007/s00586-021-06865-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/05/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To clarify the current state of knowledge on the association of endplate structural defects and back pain. METHODS Five databases were searched for studies reporting on the association between endplate structural defects and back pain. Covidence and comprehensive meta-analysis software were used for article screening and selection and pooling of extracted data. Overall quality of evidence was assessed using GRADE. RESULTS Twenty-six studies comprised of 11,027 subjects met inclusion criteria. The presence of moderate heterogeneity (I2 = 73%; p = 0.001) prevented the pooling of estimates across all studies. However, it was possible to pool studies of specific endplate defect phenotypes, such as erosion (OR: 2.69; 95% CI: 1.35-5.50) and sclerosis (OR: 1.97; 95% CI: 1.50-2.58), which yielded significant associations with back pain. Schmorl's nodes were also associated with most individual back pain phenotypes (OR: 1.53-1326, I2 = 0-7.5%) and back pain overall (OR: 1.63, 95% CI: 1.37-1.94, I2 = 26%) in general population samples. The pooling of data from all studies of specific back pain phenotypes, such as frequent back pain (OR: 2.83; 95% CI: 1.77-4.52) and back pain incidence (OR: 1.65; 95% CI: 1.30-2.10), each yielded significant association with endplate structural defects and was supported by low heterogeneity (I2 = < 7.5.%). CONCLUSION Overall, there is moderate quality evidence of an association between back pain and endplate structural defects, which is most evident for erosion, sclerosis and Schmorl's nodes. Going forward, research on specific endplate defect phenotypes and back pain case definitions using strong study designs will be important in clarifying the extent of associations and underlying mechanisms. The study was prospectively registered in Prospero (CRD42020170835) on 02/24/2020.
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27
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Fritzell P, Bergström T, Jönsson B, Andersson SGE, Skorpil M, Udby PM, Andersen M, Hägg O. Antibiotics should not be used for back/leg pain. Acta Orthop 2021; 92:1-3. [PMID: 33302755 PMCID: PMC7919897 DOI: 10.1080/17453674.2020.1855561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Peter Fritzell
- RKC Centre for Spine Surgery in Stockholm, Sweden/Futurum, Academy for Health and Care, Region Jönköping County, Sweden; ,Correspondence:
| | - Tomas Bergström
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Sweden;
| | | | - Siv G E Andersson
- Department of Cell and Molecular Biology, Biomedical Center, Uppsala University, Sweden;
| | | | - Peter Muhareb Udby
- Spine Unit, Ortopaedkirurgisk Afdeling, Sjaellands Universitetshospital, Køge, Denmark;
| | - Mikkel Andersen
- Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark;
| | - Olle Hägg
- Spine Center Göteborg, Västra Frölunda, Sweden
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28
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Kitiş S, Çevik S, Kaplan A, Yılmaz H, Katar S, Cömert S, Ünsal ÜÜ. Relationship Between Degeneration or Sagittal Balance With Modic Changes in the Cervical Spine. Cureus 2021; 13:e12949. [PMID: 33527064 PMCID: PMC7842237 DOI: 10.7759/cureus.12949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: This study evaluates the relationship between degenerative and Modic changes (MCs) in the cervical spine and compares the results with the cervical sagittal balance parameters. Methods: We retrospectively reviewed 275 patients with neck pain who applied to our outpatient clinic and underwent cervical magnetic resonance imaging (MRI) and cervical anteroposterior (AP)/lateral (Lat) X-ray radiography between January 2016 and January 2018. The clinics, demographic information, and radiological findings of the patients were examined. Modic changes, disc degeneration, and facet degeneration (FD) were examined by cervical MRI, and T1 slope and Cobb angle were measured by cervical AP/Lat X-ray radiography. These results were compared to evaluate their relations with each other. Results: No relationship between the presence or absence of degenerative changes (Modic changes, facet degeneration, and disc degeneration) and sagittal balance parameters (T1 slope and Cobb angle) was found. However, when each cervical segment was examined separately, facet degeneration at the C4-C5 level and Modic changes at the C3-C4, C4-C5, and C6-C7 levels were statistically significant with the Cobb angles, and the Modic changes at the C3-C4 level and disc degeneration at the C2-C3 level were found to be significant with T1 slope values. Conclusions: Our findings indicate that MCs increased with decreased cervical curvature, increasing disc and facet degeneration, although the causal mechanisms are not clear.
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Affiliation(s)
- Serkan Kitiş
- Neurosurgery, Bezmialem University, Istanbul, TUR
| | - Serdar Çevik
- Neurosurgery, Memorial Şişli Hospital, Istanbul, TUR.,School of Health Sciences, Gelişim University, Istanbul, TUR
| | - Atilla Kaplan
- Department of Radiology, Yalova State Hospital, Yalova, TUR
| | | | - Salim Katar
- Department of Neurosurgery, Balıkesir Üniversitesi, Balıkesir, TUR
| | - Serhat Cömert
- Department of Neurosurgery, Yenimahalle Training and Research Hospital, Ankara, TUR
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29
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Basivertebral Nerve Ablation for the Treatment of Vertebrogenic Pain. Pain Ther 2020; 10:39-53. [PMID: 33128702 PMCID: PMC8119576 DOI: 10.1007/s40122-020-00211-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/08/2020] [Indexed: 12/19/2022] Open
Abstract
Chronic low back pain affects a significant portion of patients worldwide and is a major contributor to patient disability; however, it is a difficult problem to diagnose and treat. The prevailing model of chronic low back pain has presumed to follow a discogenic model, but recent studies have shown a vertebrogenic model that involves the basivertebral nerve (BVN). Radiofrequency ablation of the BVN has emerged as a possible nonsurgical therapy for vertebrogenic low back pain. The objective of this manuscript is to provide a comprehensive review of vertebrogenic pain diagnosis and our current understanding of BVN ablation as treatment.
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30
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Association between types of Modic changes in the lumbar region and low back pain in a large cohort: the Wakayama spine study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:1011-1017. [PMID: 33037486 DOI: 10.1007/s00586-020-06618-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/18/2020] [Accepted: 09/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The clinical significance of Modic changes in low back pain (LBP) is yet to be clarified. Thus, this study aimed to examine the association between Modic changes and LBP after adjustment for confounding factors. METHODS We evaluated participants in the second Wakayama Spine Study. The degree of endplate changes as measured using magnetic resonance imaging was classified based on the Modic classification system. The prevalence of the types of Modic change in the lumbar region and at each level was assessed. Multivariate logistic regression analysis was conducted to determine the association between the types of Modic changes and LBP with adjustment for age, sex, body mass index, disc degeneration score, and disc displacement score. The LBP intensity was also compared according to the Visual Analogue Scale (VAS) score among the three types of Modic change. RESULTS Overall, 814 subjects were evaluated. Type II Modic changes were the most prevalent (41.9%). Only type I Modic changes were significantly associated with LBP (odds ratio): 1.84, 95% confidence interval [CI]: 1.1-2.9). The LBP VAS score was significantly higher in subjects with type I Modic change than that in those with no Modic change (23.9 ± 26.3 vs. 9.9 ± 19.4, p < 0.05). CONCLUSION Type I Modic changes in the lumbar region are significantly associated with LBP. Profiling Modic changes may be helpful to improve targeted treatment of LBP.
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Wang J, Zheng Z, Huang B, Wu H, Zhang X, Chen Y, Liu J, Shan Z, Fan S, Chen J, Zhao F. Osteal Tissue Macrophages Are Involved in Endplate Osteosclerosis through the OSM-STAT3/YAP1 Signaling Axis in Modic Changes. THE JOURNAL OF IMMUNOLOGY 2020; 205:968-980. [PMID: 32690652 DOI: 10.4049/jimmunol.1901001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 06/22/2020] [Indexed: 11/19/2022]
Abstract
Modic changes (MCs) are radiographic manifestations of lumbar degenerative diseases. Various types of MCs are often associated with endplate osteosclerosis. Osteal tissue macrophages (Osteomacs) were reported to be crucial for bone homeostasis and bone repair, but whether osteomacs participate in the endplate osteosclerosis in MCs remained unclear. In this study, we tried to explore the critical role of osteomacs in regulating osteogenesis in MCs. We collected MCs from patient samples and developed a Propionibacterium acnes-induced rat MCs model, using microcomputed tomography and immunohistochemistry to detect the endplate bone mass and distribution of osteomacs. In patients' MCs, osteomacs increased in endplate subchondral bone, especially in Modic type II. Endplate in Modic type III presented a stable osteosclerosis. In rat MCs model, osteomacs increased in the bone hyperplasia area but not in the inflammation area of the endplate region, whereas the distribution of osteomacs was consistent with the area of osteosclerosis. To further explore the functions of osteomacs in vitro, we isolated osteomacs using MACS technology and found osteomacs secreted oncostatin M (OSM) and strongly promoted osteoblast differentiation rather than osteoclast through the mechanism of OSM-mediated tyrosine phosphorylation and interaction of STAT3 and Yes-associated protein 1 (YAP1). STAT3 phosphorylation inhibition or YAP1 knockdown attenuated OSM-mediated osteoblast differentiation. Finally, we confirmed that blockade of OSM in vivo using anti-OSM-neutralizing Ab prevented endplate osteosclerosis in rat MCs model. Taken together, these findings confirmed that endplate osteosclerosis in MCs was accompanied by an increased number of osteomacs, which regulated osteogenesis via the OSM-STAT3/YAP1 signaling axis.
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Affiliation(s)
- Jiasheng Wang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; and Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou 310016, China
| | - Zeyu Zheng
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; and Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou 310016, China
| | - Bao Huang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; and Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou 310016, China
| | - Hao Wu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; and Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou 310016, China
| | - Xuyang Zhang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; and Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou 310016, China
| | - Yilei Chen
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; and Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou 310016, China
| | - Junhui Liu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; and Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou 310016, China
| | - Zhi Shan
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; and Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou 310016, China
| | - Shunwu Fan
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; and Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou 310016, China
| | - Jian Chen
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; and Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou 310016, China
| | - Fengdong Zhao
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; and Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou 310016, China
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Baker JD, Harada GK, Tao Y, Louie PK, Basques BA, Galbusera F, Niemeyer F, Wilke HJ, An HS, Samartzis D. The Impact of Modic Changes on Preoperative Symptoms and Clinical Outcomes in Anterior Cervical Discectomy and Fusion Patients. Neurospine 2020; 17:190-203. [PMID: 32252168 PMCID: PMC7136113 DOI: 10.14245/ns.2040062.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/16/2020] [Indexed: 12/16/2022] Open
Abstract
Objective To assess the impact of Modic changes (MC) on preoperative symptoms, and postoperative outcomes in anterior cervical discectomy and fusion (ACDF) patients.
Methods We performed a retrospective study of prospectively collected data of ACDF patients at a single institution. Preoperative magnetic resonance imagings were used to assess the presence of MC. MC were stratified by type and location, and compared to patients without MC. Associations with symptoms, patient-reported measures, and surgical outcomes were assessed.
Results A total of 861 patients were included, with 356 patients with MC (41.3%). MC more frequently occurred at C5–6 (15.1%), and type II was the most common type (61.2%). MC were associated with advanced age (p < 0.001), more levels fused (p < 0.001), a longer duration of symptoms, but not with specific symptoms. MC at C7–T1 resulted in higher postoperative disability (p < 0.001), but did not increase risk of adjacent segment degeneration or reoperation.
Conclusion This study is the first to systematically examine the impact of cervical MC, stratified by type and location, on outcomes in ACDF patients. Patients with MC were generally older, required larger fusions, and had longer duration of preoperative symptoms. While MC may not affect specific outcomes following ACDF, they may indicate a more debilitating preoperative state for patients.
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Affiliation(s)
- James D Baker
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, IL, USA
| | - Garrett K Harada
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, IL, USA
| | - Youping Tao
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Philip K Louie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, IL, USA
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, IL, USA
| | | | - Frank Niemeyer
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, IL, USA
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, IL, USA
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Chen L, Battié MC, Yuan Y, Yang G, Chen Z, Wang Y. Lumbar vertebral endplate defects on magnetic resonance images: prevalence, distribution patterns, and associations with back pain. Spine J 2020; 20:352-360. [PMID: 31669615 DOI: 10.1016/j.spinee.2019.10.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/26/2019] [Accepted: 10/18/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although the roles of Modic Changes (MCs) and disc degeneration in back pain remain controversial, clues from cadaveric studies suggest that lumbar vertebral endplate lesions may be important in back pain. Endplate lesions can be detected on magnetic resonance (MR) images as various endplate defects, including focal, corner, and erosive defects. Yet, the clinical significance of such endplate defects remains unknown. PURPOSE To determine the prevalence and distribution patterns of lumbar vertebral endplate defects and their associations with back pain in a population-based sample. STUDY DESIGN Cross-sectional study. PATIENT SAMPLE Subjects were randomly selected from a typical community in Hangzhou Eastern China, regardless of back pain status. OUTCOME MEASURES Each subject underwent a structured interview and lumbar MR imaging. Back pain history, including today, over the past 4 weeks, 12 months, and lifetime, were acquired. Endplate defects, MCs, and disc degeneration were evaluated on MRIs. Age, gender and body mass index (kg/m2), as well as lifetime exposures, including smoking history, riding in motorized vehicles and associated vibration, and occupational physical demands were assessed. METHODS Descriptive statistics were used to depict prevalence and distribution patterns of endplate defects in the lumbar spine. Logistic regressions were used to examine associations of endplate defects with back pain. The research grant was obtained from the National Natural Science Foundation of China (115,000 USD), Key Platform Project of the Health Department of Zhejiang Province (14,000 USD), Technology Program of Traditional Chinese Medicine Department of Zhejiang Province (21,000 USD), and 2015 Qianjiang Talent Program of Zhejiang Province (7,000 USD) toward this work. There is no conflict to disclose. RESULTS There were 478 subjects (53.3±14.4 years, range 20-88 years) studied. Endplate defects presented in 301 (63.0%) subjects and 842 (16.0%) endplates. The presence of endplate defects, but not MCs and disc degeneration, was associated with lifetime back pain (odds ratio=1.64, p=.026) in multivariate analyses. Focal and erosive endplate defects were associated with lifetime back pain history (odds ratio=1.74-2.23, p<.05 for both), whereas all three types of defects were associated with intensity of worst back pain over the past 12 months (Coef=5.84-7.19, p<.05 for all). CONCLUSIONS Endplate defects are common findings on lumbar MRIs in adults. Specific types of endplate defects were associated with back pain history. Endplate defects may be an independent risk factor for back pain.
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Affiliation(s)
- Lunhao Chen
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, College of medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Michele C Battié
- Faculty of Health Sciences, School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Ying Yuan
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, College of medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Ge Yang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, College of medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Zhong Chen
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, College of medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, College of medicine, Zhejiang University, Hangzhou, People's Republic of China.
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Hyperbaric oxygen treatment: A complementary treatment modality of Modic changes? Med Hypotheses 2020; 138:109617. [PMID: 32065934 DOI: 10.1016/j.mehy.2020.109617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/05/2020] [Accepted: 02/09/2020] [Indexed: 11/23/2022]
Abstract
Modic changes (MCs) have attracted great interest in recent years. The complex process of MC development and progression seems to involve interplay between mechanical, infective, inflammatory, and degenerative processes that cannot be clearly differentiated. Based on signal intensity on T1- and T2-weighted MRI scans, MCs can be divided three types: Type 1, Type 2, and Type 3. Predominantly Type 1 MCs are commonly associated with chronic low back pain that is unresponsive to classic treatment options. Infection with low-virulent anaerobic microorganisms, most commonly Propionibacterium acnes, has been implicated in MC development following a disc herniation when a tear enables bacteria to enter the disc. Recent studies in patients with chronic low back pain following a lumbar disc herniation associated with Type 1 MCs have reported promising results following prolonged systemic antibiotic treatment with amoxicillin-clavulanate. Hyperbaric oxygen therapy, as primary or adjuvant treatment in association combination with systemic antibiotics or anti-inflammatory therapy, could offer important advantages in treating patients with suspected low-virulent disc infections due to anaerobic microorganisms associated with Type 1 MCs. We believe that hyperbaric oxygenation could contribute to faster resolution of Type 1 MCs and associated pain through multiple effects-including direct antimicrobial effects through formation of reactive oxygen species (ROS), altering the favorable low oxygen tension milieu such that it becomes unfavorable for bacterial growth and survival, and anti-biofilm effects. Additionally, hyperbaric oxygenation could contribute to faster pain resolution via direct and indirect anti-inflammatory effects. As an adjuvant treatment administered in combination with systemic antibiotics, HBOT could increase the sensitivity of Propionibacterium acnes to antimicrobial drugs under hyperoxic conditions, resulting in faster MC resolution. Overall, the faster infection resolution, diminished bacterial load, and anti-inflammatory effects due to reduced cytokine expression and levels of infectious by-products could lead to faster pain resolution following HBOT, and a significant improvement of quality of life in these patients.
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Lifestyle and lifetime occupational exposures may not play a role in the pathogenesis of Modic changes on the lumbar spine MR images. Spine J 2020; 20:94-100. [PMID: 31442618 DOI: 10.1016/j.spinee.2019.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Modic changes (MCs) have long been suspected as a pathologic cause of back pain. Although much attention has been focused on clinical perspectives, the etiology of MCs remains unclear. Although some studies have reported that sex, body mass index (BMI), cigarette smoking, and physical loading may associate with MCs, the observed associations are inconsistent among studies. PURPOSE To investigate associations between MCs and lifestyle and lifetime occupational exposures using a general population sample. STUDY DESIGN Cross-sectional study. PATIENT SAMPLE The study was an extension of the Hangzhou Lumbar Spine Study, a population-based study of mainland Chinese focusing on lumbar degenerative changes. A total of 644 randomly selected subjects from a typical community in Hangzhou, Eastern China participated. OUTCOME MEASURES The presence and type of MCs in the lumbosacral spine were evaluated on sagittal magnetic resonance images. Demographics, lifestyle factors, and occupational exposures were measured using a structured interview. METHODS Univariate and multivariate logistic regressions were used to examine the associations of MCs with various environmental exposures. RESULTS Among the 644 subjects (52.6±13.9 years; range 20-88 years) included in this study, 44.7% had MCs. In univariate regression analyses, the presence of MCs was associated with greater age, higher BMI, greater cigarette smoking, regular exercise, and absence of daily vehicle vibration. Modic changes were not univariately associated with sex or alcohol consumption. In addition, all occupational loading measurements were associated with the occurrence of MCs in univariate analyses, except work time spent in vehicles and work-related back injuries. However, in multivariate regression analyses, no statistically significant associations between the occurrence of MCs and lifestyle or lifetime occupational exposures were observed after adjusting for age, sex, and BMI. CONCLUSIONS Age is an important determinant of MCs, with BMI and sex also playing a role. Lifestyle and occupational factors appear to have minor effects, if any, on the pathogenesis of MCs in the lumbar spine.
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Viswanathan VK, Shetty AP, Rajasekaran S. Modic changes - An evidence-based, narrative review on its patho-physiology, clinical significance and role in chronic low back pain. J Clin Orthop Trauma 2020; 11:761-769. [PMID: 32879563 PMCID: PMC7452231 DOI: 10.1016/j.jcot.2020.06.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Lumbar degenerative spinal ailments are the most important causes for chronic low back pain. Modic changes (MC) are vertebral bone marrow signal intensity changes seen on MRI, commonly in association with degenerative disc disease (DDD). Despite being widely studied, majority of issues concerning MC are still controversial. The current narrative, evidence-based review comprehensively discusses the various aspects related to MC. LITERATURE SEARCH An elaborate search was made using keywords "Modic changes", "lumbar Modic changes", "Modic changes in lumbar spine", and "vertebral Endplate Spinal Changes", on pubmed and google (scholar.google.com) databases on the 3rd of March 2020. We identified crucial questions regarding Modic changes and included relevant articles pertaining to these topics for this narrative review. RESULTS The initial search using the keywords "Modic changes", "lumbar Modic changes", "Modic changes in lumbar spine", and "vertebral Endplate Spinal Changes" on pubmed yielded a total of 568, 412, 394 and 216 articles on "pubmed" database, respectively. A similar search using the aforementioned keywords yielded a total of 3650, 3548, 3726 and 21570 articles on "google scholar" database. The initial screening involved exclusion of duplicate articles, articles unrelated to MC, animal or other non-clinical studies, and articles in non-English literature based on abstracts or the titles of articles. This initial screening resulted in the identification of 405 articles. Full manuscripts were obtained for all these selected articles and thoroughly scrutinised at the second stage of article selection. All articles not concerning Modic changes, not pertaining to concerned questions, articles concerning other degenerative phenomena, articles discussing cervical or thoracic MC, case reports or animal studies, articles in non-English language and duplicate articles were excluded. Review articles, randomised controlled trials and level 1 studies were given preference. Overall, 69 articles were included in this review. CONCLUSION Modic change (MC) is a dynamic phenomenon and its true etiology is still not definitely known. Disc/end plate injury, occult discitis and autoimmune reactions seem to trigger an inflammatory cascade, which leads to their development. Male sex, older age, diabetes mellitus, genetic factors, smoking, obesity, spinal deformities, higher occupational loads and DDD are known risk factors. There is no conclusive evidence on the causative role of MC in chronic low back pain (LBP) or any influence on the long term outcome in patients with LBP or lumbar disc herniations (LDH). Patients with MC have been reported to have less satisfactory outcome following conservative treatment or discectomy, although the evidence is still unclear.
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Affiliation(s)
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Center and Hospitals, Coimbatore, India,Corresponding author.
| | - S. Rajasekaran
- Department of Spine Surgery, Ganga Medical Center and Hospitals, Coimbatore, India,Department of Orthopedics, Ganga Medical Center and Hospitals, Coimbatore, India
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When an incidental MRI finding becomes a clinical issue : Posterior lumbar subcutaneous edema in degenerative, inflammatory, and infectious conditions of the lumbar spine. Wien Klin Wochenschr 2019; 132:27-34. [PMID: 31773271 PMCID: PMC6978443 DOI: 10.1007/s00508-019-01576-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/08/2019] [Accepted: 10/28/2019] [Indexed: 11/05/2022]
Abstract
Background On magnetic resonance imaging (MRI), posterior lumbar subcutaneous edema (PLSE) is a frequent incidental, yet unclear finding within the deep subcutaneous perifascial tissue. This study aimed to investigate PLSE in various pathological lumbar conditions. Methods This retrospective study included the MR images of the lumbar spine of 279 patients (age range 18–82 years) without cardiovascular, renal or hepatic diseases, 79 of whom had low-grade disc degeneration, 101 combined endplate and facet joint degeneration, 53 axial spondyloarthritis and 46 infectious spondylodiscitis. There were 232 patients with a body mass index (BMI) <30, and 47 with a BMI ≥30 (obese). For each group, the relationship between PLSE and BMI was analyzed using multiple logistic regression, and between PLSE extension and BMI using ordinal regression. Results A PLSE was found in 11/79 (13.9%) patients with disc degeneration, 37/101 (36.6%) with endplate and facet joint degeneration, 7/53 (13.2%) with spondyloarthritis, and 28/46 (60.9%) with spondylodiscitis. For each group, a statistically significant relationship was demonstrated between PLSE and BMI (P = 0.000–P = 0.031), except for spondylodiscitis (P = 0.054), as well as between PLSE extension and BMI (P = 0.000–P = 0.049). A PLSE was found in 21.1% of nonobese and 72.3% of obese patients (P = 0.000). Conclusion The presence of PLSE seems to be associated with various lumbar conditions, particularly in obese patients. Its perifascial location may suggest a potential fascial origin; however, PLSE should not to be confused with posttraumatic, postsurgical or infectious edema or edema associated with internal diseases.
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Lv B, Fan X, Ding H, Ji P, Zhao Y, Wan B, Jiang Q, Luo Y, Xu T, Zhou Z, Chen J, Yuan J, Wang L, Huang A. Analysis of Correlation Between Age and Cervical Facet Joint Degeneration and Modic Changes in Patients with Cervical Spondylotic Myelopathy. Med Sci Monit 2019; 25:7882-7888. [PMID: 31634342 PMCID: PMC6820335 DOI: 10.12659/msm.915136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Because facet joints move with the disc, changes in vertebral bodies occur simultaneously with progression of degeneration of cervical facet joints. This study investigated age-related differences in cervical facet joint abnormalities and multi-dimensional characteristics of MCs in patients with cervical spondylotic myelopathy. Material/Methods Forty-five patients underwent both magnetic resonance imaging (MRI) and computed tomography (CT) of the cervical spine. Axial and sagittal parameter changes from C3 to C7, including facet orientation (FO) and facet tropism (FT), and Modic changes (MCs), were evaluated and documented preoperatively, and we also measured the heights and diameters of MCs and performed correlation analysis and established linear regression models. Results The axial facet orientation increased slightly from C3 66.5 (11.4) to C7 89.9 (19). The sagittal facet orientation and facet tropism increased between C3–C4 and C6–C7, but it decreased between C4 to C6. The MCs volume decreased from C3 to C4 and increased from C4 to C7. There was a gradual decrease of FO and FT from C3 to C5 and a gradual increase of these 2 angles from C5 to C7 in all age groups. The lowest values of FO and FT were detected at C5, while the highest values of FO and FT were detected at C7. Conclusions Age was negatively correlated with the axial, sagittal, and coronal cervical facet orientation, especially at C4/5 level. The FT with respect to the axial and sagittal plane from C5 to C6 increased with age.
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Affiliation(s)
- Bin Lv
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu, China (mainland)
| | - Xiaochen Fan
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu, China (mainland)
| | - Hua Ding
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu, China (mainland)
| | - Peng Ji
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu, China (mainland)
| | - Yilei Zhao
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu, China (mainland)
| | - Bowen Wan
- Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Qinyi Jiang
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu, China (mainland)
| | - Yongjun Luo
- Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Tao Xu
- Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Zhimin Zhou
- Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Jian Chen
- Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Jishan Yuan
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu, China (mainland)
| | - Lei Wang
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu, China (mainland)
| | - Anquan Huang
- Department of Orthopedics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China (mainland)
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Bostelmann R, Petridis A, Fischer K, Vajkoczy P, Bostelmann T, Barth M. New insights into the natural course and clinical relevance of Modic changes over 2 years following lumbar limited discectomy: analysis of prospective collected data. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2551-2561. [PMID: 31055663 DOI: 10.1007/s00586-019-05988-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/04/2019] [Accepted: 04/21/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Few retrospective studies have addressed Modic changes (MC) following lumbar spine surgery, though it is usually assumed that MC increase in grade and incidence. To test this conventional wisdom, we investigated the natural course of MC following primary lumbar limited discectomy with two-year follow-up. In addition, a possible clinical relevance to those changes was assessed. METHODS The data of the control group (278 subjects) of a prospective randomized, controlled trial (RCT) were evaluated retrospectively. RESULTS We did not observe a simple increase in MC with regard to grade. There is variable activity observed in Type 2 (at 12 months) and in Type 1 (at 24 months). Conversion from one grade to another may occur and may be upward or downward. The incidence of MC increased slightly over time, as after surgery a decreasing percentage of the study group remained without MC over two years (1 year: 34% (85/250); 2 years: 30% (72/237)). Radiological parameters (rotation, translation, and spondylolisthesis) had no significant correlation to MC or MC subtypes. Lastly, we found that neither the different MC types nor their changes were correlated with clinical parameters (VAS back, VAS leg, ODI score) preoperatively or during follow-up. CONCLUSION The pattern of Modic changes following lumbar limited discectomy is complex, not simply increasing. There is variable activity in MC Types 1 and 2 at the different time points of follow-up, and conversion from a higher grader to a lower one or vice versa is possible. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Richard Bostelmann
- Department of Neurosurgery, Medical Faculty, University Hospital Duesseldorf, Moorenstrasse 5, 40225, Duesseldorf, Germany.
| | - Athanasios Petridis
- Department of Neurosurgery, Medical Faculty, University Hospital Duesseldorf, Moorenstrasse 5, 40225, Duesseldorf, Germany
| | - Katinka Fischer
- Mathematical Institute, Heinrich Heine University, Duesseldorf, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité Universitätsmedizin, Berlin, Germany
| | - Tamara Bostelmann
- Department of Neurosurgery, Medical Faculty, University Hospital Duesseldorf, Moorenstrasse 5, 40225, Duesseldorf, Germany
| | - Martin Barth
- Department of Neurosurgery, Klinikum Frankfurt Höchst, Frankfurt, Germany
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Freidin M, Kraatari M, Skarp S, Määttä J, Kettunen J, Niinimäki J, Karppinen J, Williams F, Männikkö M. Genome-wide meta-analysis identifies genetic locus on chromosome 9 associated with Modic changes. J Med Genet 2019; 56:420-426. [PMID: 30808802 DOI: 10.1136/jmedgenet-2018-105726] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/18/2018] [Accepted: 01/11/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Low back pain (LBP) is a common disabling condition. Lumbar disc degeneration (LDD) may be a contributing factor for LBP. Modic change (MC), a distinct phenotype of LDD, is presented as a pathological bone marrow signal change adjacent to vertebral endplate on MRI. It is strongly associated with LBP and has heritability around 30%. Our objective was to identify genetic loci associated with MC using a genome-wide meta-analysis. METHODS Presence of MC was evaluated in lumbar MRI in the Northern Finland Birth Cohort 1966 (n=1182) and TwinsUK (n=647). Genome-wide association analyses were carried out using linear regression model. Inverse-variance weighting approach was used in the meta-analysis. RESULTS A locus associated with MC (p<5e-8) was found on chromosome 9 with the lead SNP rs1934268 in an intron of the PTPRD gene. It is located in the binding region of BCL11A, SPI1 and PBX3 transcription factors. The SNP was nominally associated with LBP in TwinsUK (p=0.001) but not associated in the UK Biobank (p=0.914). Suggestive signals (p<1e-5) were identified near XKR4, SCIN, MGMT, DLG2, ZNF184 and OPRK1. CONCLUSION PTPRD is a novel candidate gene for MC that may act via the development of cartilage or nervous system; further work is needed to define the mechanisms underlying the pathways leading to development of MC. This is the first genome-wide meta-analysis of MC, and the results pave the way for further studies on the genetic factors underlying the various features of spine degeneration and LBP.
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Affiliation(s)
- Maxim Freidin
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK
| | - Minna Kraatari
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Faculty of Biochemistry and Molecular Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Sini Skarp
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Faculty of Biochemistry and Molecular Medicine, University of Oulu, Oulu, Finland
| | - Juhani Määttä
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Johannes Kettunen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - Jaakko Niinimäki
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Jaro Karppinen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Finnish Institute of Occupational Health, Oulu, Finland
| | - Frances Williams
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK
| | - Minna Männikkö
- Northern Finland Birth Cohorts, Faculty of Medicine, University of Oulu, Oulu, Finland
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van der Wurff P, Vredeveld T, van de Graaf C, Jensen RK, Jensen TS. Exploratory study for clinical signs of MODIC changes in patients with low-back pain in the Netherlands armed forces. Chiropr Man Therap 2019; 27:5. [PMID: 30809377 PMCID: PMC6375199 DOI: 10.1186/s12998-018-0229-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/19/2018] [Indexed: 01/23/2023] Open
Abstract
Background Magnetic resonance imaging (MRI) is being used extensively in the search for pathoanatomical factors contributing to low back pain (LBP) such as Modic changes (MC). However, it remains unclear whether clinical findings can identify patients with MC. The purpose of this explorative study was to assess the predictive value of six clinical tests and three questionnaires commonly used with patients with low-back pain (LBP) on the presence of Modic changes (MC). Methods A retrospective cohort study was performed using data from Dutch military personnel in the period between April 2013 and July 2016. Questionnaires included the Roland Morris Disability Questionnaire, Numeric Pain Rating Scale, and Pain Self-Efficacy Questionnaire. The clinical examination included (i) range of motion, (ii) presence of pain during flexion and extension, (iii) Prone Instability Test, and (iv) straight leg raise. Backward stepwise regression was used to estimate predictive value for the presence of MC and the type of MC. The exploration of clinical tests was performed by univariable logistic regression models. Results Two hundred eighty-six patients were allocated for the study, and 112 cases with medical records and MRI scans were available; 60 cases with MC and 52 without MC. Age was significantly higher in the MC group. The univariate regression analysis showed a significantly increased odds ratio for pain during flexion movement (2.57 [95% confidence interval (CI): 1.08–6.08]) in the group with MC. Multivariable logistic regression of all clinical symptoms and signs showed no significant association for any of the variables. The diagnostic value of the clinical tests expressed by sensitivity, specificity, positive predictive, and negative predictive values showed, for all the combinations, a low area under the curve (AUC) score, ranging from 0.41 to 0.53. Single-test sensitivity was the highest for pain in flexion: 60% (95% CI: 48.3–70.4). Conclusion No model to predict the presence of MC, based on clinical tests, could be demonstrated. It is therefore not likely that LBP patients with MC are very different from other LBP patients and that they form a specific subgroup. However, the study only explored a limited number of clinical findings and it is possible that larger samples allowing for more variables would conclude differently.
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Affiliation(s)
- Peter van der Wurff
- Research and Development, Military Rehabilitation Centre Aardenburg, Doorn, The Netherlands.,2Institute for Human Movement Sciences, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Tom Vredeveld
- 3School of Physiotherapy, Faculty of Heath, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Caroline van de Graaf
- Research and Development, Military Rehabilitation Centre Aardenburg, Doorn, The Netherlands
| | - Rikke K Jensen
- 4Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Tue S Jensen
- 4Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.,Department of Diagnostic Imaging, Silkeborg Regional Hospital, Silkeborg, Denmark
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Wu JP, Wang QB, Feng XJ, Wang Q, Cheng MH. Relationship Between Modic Changes and Sagittal Balance Parameters in the Cervical Spine. Med Sci Monit 2018; 24:6102-6106. [PMID: 30173243 PMCID: PMC6131981 DOI: 10.12659/msm.909773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background We explored the possible relationship between Modic changes (MCs) and sagittal parameters of the cervical spine. Material/Methods We enrolled 150 patients with cervical MC on the magnetic resonance imaging (MRI) scans in the MC (+) group and divided them into 3 sub-groups with 50 patients each: the MC1 sub-group, the MC2 sub-group, and the MC3 sub-group. Another 150 healthy subjects receiving routine health examinations were also enrolled in the study as the MC (−) group. The sagittal parameters in the cervical spine were measured and compared and multiple logistic regression analysis was performed to analyze the risk factor for the occurrence of MC. Results Four cervical sagittal parameters were measured and compared between all the enrolled groups, including neck tilt (NT), T1 slope (T1s), thoracic inlet angle (TIA), and Cobb C2–C7. The results confirmed that the parameter of Cobb C2–C7 was much smaller in the MC(+) group when compared with that in the MC(−) group (P<0.05), while no significant differences were detected between the MC(+) and MC(−) groups for the parameters of NT, T1 T1s, and TIA (P>0.05). Multiple logistic regression analysis showed that Cobb C2–C7 (less than 8.5°) could be regarded as the risk factor for the occurrence of MC, and the receiver operating characteristic (ROC) curve showed that moderate diagnostic significance was obtained with an area under curve (AUC) of 0.82. Conclusions The present study demonstrated that Cobb C2–C7 (less than 8.5°) is a potential risk factor for the development of MC.
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Affiliation(s)
- Jian-Ping Wu
- Department of Orthopaedics, People's Hospital of Yixing, Yixin, Jiangsu, China (mainland)
| | - Quan-Bin Wang
- Department of Orthopedics, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China (mainland)
| | - Xiao-Jun Feng
- People's Hospital of Xishan District, Wux, Jiangsu, China (mainland)
| | - Qiang Wang
- Department of Orthopaedics, People's Hospital of Yixing, Yixin, Jiangsu, China (mainland)
| | - Mao-Hua Cheng
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow, Suzhou, Jiangsu, China (mainland)
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Modic Changes in the Lumbar Spine are Common Aging-related Degenerative Findings that Parallel With Disk Degeneration. Clin Spine Surg 2018; 31:312-317. [PMID: 29847414 DOI: 10.1097/bsd.0000000000000662] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This is a cross-sectional study. OBJECTIVE To determine the prevalence and distribution patterns of Modic changes (MCs) in the lumbar spine and their associations with disk degeneration in mainland Chinese using a sample of general population. SUMMARY OF BACKGROUND DATA Previous studies reported that the prevalence of MCs in Hong Kong Chinese was much lower than in other populations. Moreover, their associations with disk degeneration need further study. MATERIALS AND METHODS The study sample consisted of 442 subjects (53.6±14.9 y; range, 20-88 y) randomly selected from a typical Chinese community. Lumbar spines were imaged using a 3.0 T magnetic resonance scanner. Eleven endplates (L1-S1) in the lumbar spine were evaluated for the presence of MCs, type, location, and size to determine MCs prevalence and distribution patterns. Disk degeneration was graded using a Pfirrmann scale. RESULTS MCs were present in 209 (47.3%) subjects and 593 (12.2%) endplates. Among these endplates, 84.1% (499) were type II, 9.1% (54) were type I, and 6.4% (38) were mixed MCs. Approximately 2/3 MCs were present in the lower lumbar spine and 44.9% of MCs were at the L5/S1 disk level. Most MCs (73.9%) involved both endplates of a disk. Greater age [odds ratio (OR)=2.44 for each 10-year increase, P<0.001] and body mass index (OR=1.07, P=0.016) were associated with the presence of MCs, as was adjacent disk degeneration (OR=6.00, P<0.001), controlling for age and other covariates. Greater age, body mass index, and adjacent disk degeneration were also associated with greater MCs size. CONCLUSIONS MCs are common in mainland Chinese, with type II predominating. MCs mainly present in the lower lumbar region and tend to occur in pairs. MCs were strongly associated with age and disk degeneration, suggesting MCs may be aging-related degenerative findings that parallel disk degeneration. LEVEL OF EVIDENCE Level II.
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Hu XJ, Chen LH, Battié MC, Wang Y. Methodology and cohort profile for the Hangzhou Lumbar Spine Study: a study focusing on back health in a Chinese population. J Zhejiang Univ Sci B 2018; 19:547-558. [PMID: 29971993 PMCID: PMC6052362 DOI: 10.1631/jzus.b1700484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/05/2017] [Accepted: 11/05/2017] [Indexed: 12/19/2022]
Abstract
Back pain is a worldwide health problem, adding a tremendous burden to modern societies. However, little information on back health is available in China, even though a quarter of the world's population is Chinese. To enhance knowledge in this area, we designed and initiated the Hangzhou Lumbar Spine Study, which is a cross-sectional study of a general sample of mainland Chinese with focusing on disc degeneration, Modic changes, endplate lesions, and back pain. The study consists of a structured questionnaire to measure back pain history and lifetime exposure to suspected risk factors, magnetic resonance imaging of the lumbar spine, bone mineral density study of the spine and hip, and DNA sample analysis. Here we briefly introduce the study methodology, report the test-retest reliability of the questionnaire, and describe the cohort profile to date. Since May 2014, 301 randomly selected subjects (male/female, 122/179; mean age, 51.0 years; range, 20-87 years) have been recruited. Tests-retests of the questionnaire, completed by 40 participants, revealed good reliability. To our knowledge, the Hangzhou Lumbar Spine Study is the first population-based epidemiological study conducted to characterize lumbar spinal phenotypes and back pain, their interaction, and their associations with lifetime environmental exposure, in mainland Chinese. Epidemiological information obtained from a reliable questionnaire, magnetic resonance (MR) imaging data, dual energy X-ray absorptiometry (DXA) measurements, and DNA analysis may serve as a valuable reference for future studies on back health, particularly for mainland Chinese.
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Affiliation(s)
- Xiao-jian Hu
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Lun-hao Chen
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Michele C. Battié
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton AB T6G 2G4, Canada
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
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Lumbar Vertebral Endplate Defects on Magnetic Resonance Images: Classification, Distribution Patterns, and Associations with Modic Changes and Disc Degeneration. Spine (Phila Pa 1976) 2018; 43:919-927. [PMID: 29019806 DOI: 10.1097/brs.0000000000002450] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional magnetic resonance (MR) imaging study. OBJECTIVE To classify and characterize endplate defects using routine lumbar MR images and to determine associations of endplate defects with Modic changes (MCs) and disc degeneration. SUMMARY OF BACKGROUND DATA Previously, a cadaveric study revealed that endplate lesions were common and associated with back pain history. New in vivo approaches appropriate for clinical studies are needed to further this potentially important line of research on the clinical significance of endplate lesions, including their relation with MCs, disc degeneration, and back pain. METHODS Using a MRI archive, 1564 endplates of 133 subjects (59 men and 74 women, mean age 58.9 ± 11.9 years) with the presence of MCs were retrospectively collected from April of 2014 to June of 2015. On the basis of morphological characteristics, a protocol was proposed to identify three distinct types of endplate defects, including focal, corner, and erosive defects. The location, size, and distribution patterns of various endplate lesions were characterized. MCs and disc degeneration were measured to examine their associations with endplate defects. RESULTS Endplate defects were observed in 27.8% of endplates studied. Greater age was associated with the presence of endplate defects. Focal defects were the most common (13.5%), followed by erosive defects (11.1%) and corner defects (3.2%). Defect types also differed in size and distribution patterns. Endplate defects and MCs had similar distribution patterns in the lumbar spine. The presence of endplate defects were associated with the presence of MCs (odds ratio = 4.29, P < 0.001), and associated with less disc signal intensity and disc height, and greater disc bulging (P < 0.05). CONCLUSION The three endplate defects identified on routine MR images appear to represent different pathologies and may play a key role in the pathogenesis of MCs. This classification system may facilitate clinical studies on endplate defects. LEVEL OF EVIDENCE 4.
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Romero-Muñoz L, Barriga-Martín A, Segura-Fragoso A, Martín-González C. Are Modic changes in patients with chronic low back pain indicative of a worse clinical course? 10 years of follow-up. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2018.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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The Pathology of Type II Modic Changes: Fat Deposition or Osteosclerosis? A Study Using CT Scan. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6853720. [PMID: 29967778 PMCID: PMC6008722 DOI: 10.1155/2018/6853720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/18/2018] [Accepted: 05/07/2018] [Indexed: 01/21/2023]
Abstract
Study Design A retrospective cross-sectional study of type II Modic changes (MCs). Objective To evaluate the CT values of type II MCs and determine their relationship with disc degeneration. Methods 124 type II MCs from 66 patients' MRI and CT were included and analyzed. Disc degeneration adjacent to MCs was evaluated based on Pfirrmann classification. CT values of bone marrow area and endplate from MC regions, adjacent non-MC regions, and L1 vertebra were measured. CT value changes (ΔCT value) were defined as MCs' CT value minus non-MCs'. According to the types of variables, paired t-test, signed-rank test, two-way ANOVA, and Friedman test were used. Results The CT value of MCs was significantly higher than that of non-MCs at both bone marrow area and endplate (P<0.0001, resp.). Good consistency was found between non-MCs and L1 vertebra in the CT value of bone marrow area and endplate (P=0.2129, P=0.2272, resp.), suggesting the control group was valid. Adjacent to type II MCs, there were 8 (6.4%) discs with grade III degeneration, 58 (46.8%) with grade IV, and 58 (46.8%) with grade V. The ΔCT value of grade V disc degeneration was larger than that of grade IV at the endplate (P=0.0150). Conclusions Osteosclerosis may exist in type II MCs. The more severe the degeneration of the adjacent disc, the greater the degree of osteosclerosis.
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Are Modic changes in patients with chronic low back pain indicative of a worse clinical course? 10 years of follow-up. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 62:274-281. [PMID: 29615369 DOI: 10.1016/j.recot.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/18/2017] [Accepted: 01/10/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Establish the long-term (10 years) predictive value of Modic changes in the course of lumbar pain and the need for surgical treatment. MATERIAL AND METHOD Observational longitudinal prospective cohort study. Comparison of progression at 10 years of 2 groups of patients with chronic lumbar pain: group A with Modic changes in MRI and group B with no Modic changes. EXCLUSION CRITERIA neoplasia, inflammatory or infectious diseases, or previous surgery. Assessment was done with the aid of the VAS for low lumbar and radicular pain and the Oswestry Disability Questionnaire. The need for surgical or medical treatment and occupational disability during the study period was analyzed. For the statistical analyses, the Mann-Whitney U test and logistic regression were applied. RESULTS Seventy patients, 24 male and 46 female, with a mean age of 56.5 years (35 in each group) were included in the study. No statistically significant differences in the intensity of lumbar pain, degree of impairment, or need for medical or surgical treatment (P>.05) were found in patients with Modic changes types 1, 2, or 3 between the baseline assessment and 10 years after. No statistically significant differences between patients with/without changes in Modic at 10 years of follow-up (P>.05) were determined. CONCLUSIONS There is no relationship between Modic changes in MRI and greater intensity of lumbar pain or need for medical or surgical treatment at 10 years of follow-up. Modic changes cannot be considered a sign of bad prognosis by themselves, or an indication for surgery.
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Bai J, Yu K, Sun Y, Kong L, Shen Y. Prevalence of and risk factors for Modic change in patients with symptomatic cervical spondylosis: an observational study. J Pain Res 2018; 11:355-360. [PMID: 29491718 PMCID: PMC5817419 DOI: 10.2147/jpr.s151795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background The aim of this study was to assess the prevalence of cervical Modic change (MC) in patients with cervical spondylosis and to develop a better understanding of the possible risk factors for the prevalence of MC. Methods Between January 2014 and April 2017, patients with cervical spondylosis were included in our study. All patients underwent magnetic resonance imaging (MRI) to evaluate the presence of MC. The MC was classified into three types according to the Modic classification. Potential risk factors were collected from demographic data, lifestyle variables, laboratory tests, and radiographic images. Both univariate and multivariate analysis were used to detect factors associated with MC. We further compared several variables related to fat metabolism between patients with Type 1 and Type 2 MC. Results The prevalence of MC in patients with cervical spondylosis was 9.24%. The MC was most frequent at C5–6, followed by C6–7, C4–5, and C3–4. The proportion of Type 1 MC in patients with neck pain was significantly higher than that in patients without neck pain (46.2% vs 13.6%, P=0.027). However, none of the variables associated with fat metabolism showed a significant difference between Type 1 and Type 2 MC. Multivariate logistic analysis showed that age ≥55 years (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.22–2.98) and body mass index (BMI) ≥25 kg/m2 (OR, 2.41; 95% CI, 1.62–3.59) were two significant independent factors that are associated with cervical MC in patients with cervical spondylosis (P<0.05). Conclusion It appears that advanced age and high BMI were two factors that may be responsible for cervical MC. Type 1 MC is associated with the prevalence of neck pain. However, we cannot confirm that Type 2 MC is correlated with fat metabolism.
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Affiliation(s)
- Jiangbo Bai
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Kunlun Yu
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yaning Sun
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Lingde Kong
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yong Shen
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
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Abstract
STUDY DESIGN Cross-sectional imaging study. OBJECTIVE The aim of this study was to clarify the trend in the generation distinctions about the prevalence of Modic change (MC) including elderly patients. SUMMARY OF BACKGROUND DATA MC has been discussed regarding its clinical significance, relationship with low back pain, suitable treatments, prevalence, and natural history. However, previous reports have focused on younger subjects, with few studies conducted in elderly patients. If MC is actually a progressive condition of a patient, then it should become more common as the patient ages. We herein report the distribution of MC across several age groups. METHODS Patients who underwent lumbar magnetic resonance imaging (MRI) in our institution from April 2013 to March 2015 were recruited. MC was assessed using T1- and T2-weighted magnetic resonance imaging (MRI) and divided into Modic types (MT) 1, 2, and 3, and mixed type. Trends in the prevalence of MC were analyzed based on age. RESULTS We ultimately included 585 patients of an initial 937 who underwent lumbar MRI. The mean age was 65 years. MC was identified in 36.0% of the patients. The prevalence of MC by age was 0% for those in their 10 s, 10% for those in their 20 s, 33% for those in their 30 s, 27% for those in their 40 s, 32% for those in their 50 s, 44% for those in their 60 s, 42% for those in their 70 s, and 26% for those in their 80 s. By type, 3.3% were MT1, 81.3% were MT2, 0.5% were MT3, and 14.8% were mixed type. CONCLUSION The prevalence of MC increased with age to some degree, with the highest frequency observed in individuals in their 60 s before declining in those in their 70 s and 80 s. These findings suggest that MC might not simply progress with age, particularly after the seventh decade of life. LEVEL OF EVIDENCE 4.
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