Modic changes of the lumbar spine: epidemiology and association with MRI phenotypes

Abstract

INTRODUCTION: Modic changes (MC) are associated with low back pain. The morphology, involvement and the association of MC with other spinal phenotypes remains speculative. We evaluated the relationship of MC with spinal MRI phenotypes in a large-scale population-based study. METHODS: Based on the Hong Kong Disc Degeneration Cohort, we assessed lumbar T1/T2W MRIs of 1,604 subjects (62.4% females; mean age: 49 years). The MC assessment included: the presence, type, vertical height and axial area. Additional imaging findings were assessed (herniations/bulges, Schmorl’s nodes (SN)). A global degenerative disc disease (DDD) score was tabulated. RESULTS: The prevalence of MC was 24.7% (M1: 6.3%, M2: 15.5%), mainly occurring at L4-S1. Subjects with MC were older (mean age: 53 vs. 48 years, p<0.001) and had higher DDD scores (p<0.001). M1 mainly occurred at lower levels (p=0.021), were less likely located in the anterior region only (p=0.017), and were associated with disc herniations (p<0.001) in comparison to M2. MC of the lower levels (L4-S1) were not commonly noted in the anterior region only, involved the left or right EP, and had a higher prevalence of disc herniation/degeneration in comparison to upper levels (L1-L4) (p<0.001). Large MC were more prevalent at lower levels, and had higher prevalence of disc herniation and SN at the affected level compared to smaller MC (p<0.001). CONCLUSION: Based on one of the largest studies, MC were clearly associated with disc and endplate changes. Specific MC types and level-specific findings in relation to MRI phenotypes were identified.