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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

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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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Acknowledgements

The authors wish to thank Mrs. Tamako Tsutsumi, Mrs. Kanami Maeda, and other members of the Public Office in Taiji Town for their assistance in locating and scheduling the participants for examinations. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Funding

This work was supported by H-25-Choujyu-007 (Director, NY), H25-Nanchitou (Men)-005 (Director, ST), and 201417014A (Director, NY) from the Ministry of Health, Labour and Welfare, a Grant-in-Aid for Scientific Research (C 26861206) of JSPS KAKENHI grant. And Collaborating Research with NSF 08033011–00262 (Director, NY) from the Ministry of Education, Culture, Sports, Science and Technology in Japan. This study also was supported by grants from the Japan Osteoporosis Society (NY, HO, and TA), a grant from JA Kyosai Research Institute (HO), Japan Society for the Promotion of Science, Grants-in-Aid for Scientific Research (KAKENHI) Research C (1 7 K 1 0 9 3 7) (MT), a Grant from the Japanese Orthopaedics and Traumatology Foundation, Inc (No. 287) (MT). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi Town, Ito, Wakayama, Japan

    Yoshimasa Mera & Masatoshi Teraguchi

  2. Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan

    Hiroshi Hashizume, Hidenobu Tamai & Hiroshi Yamada

  3. Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan

    Hiroyuki Oka

  4. Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan

    Shigeyuki Muraki, Toru Akune & Noriko Yoshimura

  5. Department of Orthopaedic Surgery, The University of Tokyo, Bunkyoku, Tokyo, Japan

    Hiroshi Kawaguchi, Kozo Nakamura & Sakae Tanaka

  6. Department of Orthopaedic Surgery, Sumiya Orthopaedic Hospital, Wakayama City, , Wakayama, Japan

    Munehito Yoshida

Authors
  1. Yoshimasa Mera
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Contributions

Yoshimasa Mera Initial drafted the paper; Masatoshi Teraguchi was involved in critical editing of the paper, interpreted the findings, provided administrative support, obtained the funding, and contributed to the supervision of the study and conception of study design; Hiroshi Hashizume contributed to critical editing of the paper and interpreted the findings; Hiroyuki Oka collected the data, contributed to critical editing of the paper, and interpreted the findings; Shigeyuki Muraki, Toru Akune, Hiroshi Kawaguchi, Kozo Nakamura, and Sakae Tanaka were involved in critical editing of the paper; Hidenobu Tamai collected the data and contributed to critical editing of the paper; Munehito Yoshida, Noriko Yoshimura, and Hiroshi Yamada were involved in critical editing of the paper, supervision of the study, and conception of study design.

Corresponding author

Correspondence to Masatoshi Teraguchi.

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The study was conducted with the approval of the ethics committee of our university and in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

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Mera, Y., Teraguchi, M., Hashizume, H. et al. Association between types of Modic changes in the lumbar region and low back pain in a large cohort: the Wakayama spine study. Eur Spine J 30, 1011–1017 (2021). https://doi.org/10.1007/s00586-020-06618-x

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