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European Spine Journal

, Volume 15, Issue 9, pp 1312–1319 | Cite as

Modic changes and their associations with clinical findings

  • Per KjaerEmail author
  • Lars Korsholm
  • Tom Bendix
  • Joan S. Sorensen
  • Charlotte Leboeuf-Yde
SSE Award Winning Paper 2006

Abstract

It is believed that disc degeneration (DD) is, in general, only mildly associated with low back pain (LBP). MRI-identified Modic changes (MC), probably a late stage of DD, are relatively strongly associated with LBP but it is not known if people with MC also have a specific clinical profile. The purpose of this study was to investigate if the clinical findings differ in people with Modic changes (MC) as compared to those with only degenerative disc findings or none at all. In a population-based sample of 412 40-year-old Danes, information was collected independently with MRI, questionnaires and clinical examination. Three subgroups of people were created: those with both DD and MC, those with only DD, and those with neither DD nor MC. The clinical pattern was investigated for each subgroup in order to test the assumption that the clinical picture differs in the three groups. It was expected that people with both DD and MC would have a more pronounced clinical profile than those with only DD who, in turn, would differ from those with neither of these two MRI findings. Our findings were generally in concordance with our expectations. MC constitutes the crucial element in the degenerative process around the disc in relation to LBP, history, and clinical findings. People with DD and no MC only vaguely differ from those without. People with LBP and MC may deserve to be diagnosed as having specific LBP.

Keywords

Modic changes Disc degeneration Low back pain Physical examination Clinical history Diagnosis MRI 

References

  1. 1.
    Albert HB, Manniche C (2005) Modic changes the prevalence and relationship to lumbar disc herniation. A possible new pathogenesis of low back pain (abstract, 7th annual meeting of the Spine Society of Europe, Barcelona, Spain). Eur Spine J 14(suppl. 1), ref. type: abstractGoogle Scholar
  2. 2.
    Bjørner JB, Damsgaard MT, Watt T, Bech P, Rasmussen NK, Kristensen TS, Modvig J, Thunedborg K (1997) Dansk manual til SF36. Et spørgeskema om helbredsstatusGoogle Scholar
  3. 3.
    Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW (1990) Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 72(3):403–408PubMedGoogle Scholar
  4. 4.
    Bogduk N (1997) Clinical anatomy of the lumbar spine and sacrum, 3rd edn. Churchill Livingstone, LondonGoogle Scholar
  5. 5.
    Buchanan HM, Midgley JA (1987) Evaluation of pain threshold using a simple pressure algometer. Clin Rheumatol 6(4):510–517PubMedCrossRefGoogle Scholar
  6. 6.
    Chung S-C, Kim J-H, Kim H-S (1993) Reliability and validity of the pressure pain thresholds (PPT) in the TMJ capsules by electronic algometer. J Craniomandib Pract 11(3):171–176Google Scholar
  7. 7.
    Eyre D, Nemya P, Buckwalter J, Caterson N, Heinegard D, Oegema T, Pearce R, Pope M, Urban J (1989) Intervertebral disk: basic science perspectives. In: Frymoyer JW, Gordon SL (eds) New perspectives on low back pain. American Academy of Orthopaedic Surgeons, Park Ridge, pp 147–207Google Scholar
  8. 8.
    Hansson T, Holm S (1991) Clinical implications of vibration-induced changes in the lumbar spine. Orthop Clin North Am 22(2):247–253PubMedGoogle Scholar
  9. 9.
    Heliovaara M (1989) Risk factors for low back pain and sciatica. Ann Med 21(4):257–264PubMedCrossRefGoogle Scholar
  10. 10.
    Hodges PW, Moseley GL (2003) Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol 13(4):361–370PubMedCrossRefGoogle Scholar
  11. 11.
    Indahl A, Kaigle A, Reikeras O, Holm S (1995) Electromyographic response of the porcine multifidus musculature after nerve stimulation. Spine 20(24):2652–2658PubMedCrossRefGoogle Scholar
  12. 12.
    Iwahashi M, Matsuzaki H, Tokuhashi Y, Wakabayashi K, Uematsu Y (2002) Mechanism of intervertebral disc degeneration caused by nicotine in rabbits to explicate intervertebral disc disorders caused by smoking. Spine 27(13):1396–1401PubMedCrossRefGoogle Scholar
  13. 13.
    Kendall FP, McCreary EK (1993) Muscles: testing and function, 4th edn. Lippincott Williams & Wilkins, BaltimoreGoogle Scholar
  14. 14.
    Kjaer P (2004) Low back pain in relation to lumbar spine abnormalities as identified by magnetic resonance imaging. Faculty of Health Sciences, University of Southern DenmarkGoogle Scholar
  15. 15.
    Kjaer P, Jones R, Moeller H, Enoch F (2006) Inter-observer agreement in rating five tests designed to evaluate lumbo-pelvic control (submitted)Google Scholar
  16. 16.
    Kjaer P, Korsholm L, Bendix T, Sorensen JS, Leboeuf-Yde C (2006) Modic changes—their associations with other lumbar MRI findings and their attribution to low back pain (submitted)Google Scholar
  17. 17.
    Kuorinka I, Jonsson B, Kilbom A, Biering-Sorensen F, Andersson G, Jørgensen K (1987) Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 18:233–237PubMedCrossRefGoogle Scholar
  18. 18.
    Leboeuf-Yde C, Kyvik KO (1998) At what age does low back pain become a common problem? A study of 29,424 individuals aged 12–41 years. Spine 23(2):228–234PubMedCrossRefGoogle Scholar
  19. 19.
    Liuke M, Solovieva S, Lamminen A, Luoma K, Leino-Arjas P, Luukkonen R, Riihimaki H (2005) Disc degeneration of the lumbar spine in relation to overweight. Int J Obes (Lond) 29(8):903–908CrossRefGoogle Scholar
  20. 20.
    Luoma K, Riihimaki H, Raininko R, Luukkonen R, Lamminen A, Viikari-Juntura E (1998) Lumbar disc degeneration in relation to occupation. Scand J Work Environ Health 24(5):358–366PubMedGoogle Scholar
  21. 21.
    Maitland GD, Hengeveld E, Banks K, English K (2001) Maitland’s vertebral manipulation, 6th edn. Butterworth Heinemann, Oxford, pp 152–153Google Scholar
  22. 22.
    Modic MT, Masaryk TJ, Ross JS, Carter JR (1998) Imaging of degenerative disk disease. Radiology 168(1):177–186Google Scholar
  23. 23.
    Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166(1 Pt 1):193–199PubMedGoogle Scholar
  24. 24.
    Moseley GL, Hodges PW, Gandevia SC (2003) external perturbation of the trunk in standing humans differentially activates components of the medial back muscles. J Physiol 547(Pt 2):581–587PubMedCrossRefGoogle Scholar
  25. 25.
    Paajanen H, Erkintalo M, Parkkola R, Salminen J, Kormano M (1997) Age-dependent correlation of low-back pain and lumbar disc degeneration. Arch Orthop Trauma Surg 116(1–2):106–107PubMedCrossRefGoogle Scholar
  26. 26.
    Panjabi MM (1992) The stabilizing system of the spine part II. Neutral zone and instability hypothesis. J Spinal Disord 5(4):390–396PubMedCrossRefGoogle Scholar
  27. 27.
    Raininko R, Manninen H, Battie MC, Gibbons LE, Gill K, Fisher LD (1995) Observer variability in the assessment of disc degeneration on magnetic resonance images of the lumbar and thoracic spine. Spine 20(9):1029–1035PubMedCrossRefGoogle Scholar
  28. 28.
    Rasmussen C (1998) [Lumbar disk prolapse. alcohol, tobacco and prognosis]. Ugeskr Laeger 160(36):5189–5192PubMedGoogle Scholar
  29. 29.
    Richardson C, Jull G, Hodges P, Hides J (1999) Therapeutic exercise for spinal segmental stabilization in low back pain, 1st edn. Churchill Livingstone, LondonGoogle Scholar
  30. 30.
    Roberts N, Gratin C, Whitehouse GH (1997) MRI analysis of lumbar intervertebral disc height in young and older populations. J Magn Reson Imaging 7(5):880–886PubMedCrossRefGoogle Scholar
  31. 31.
    Sorensen JS, Kjaer P, Jensen TS, Andersen P (2006) Low field magnetic resonance imaging of the lumbar spine: reliability of qualitative evaluation. Acta Radiol (in press)Google Scholar
  32. 32.
    Van Dillen LR, Sahrmann SA, Norton BJ, Caldwell CA, Fleming DA, McDonnell MK, Woolsey NB (1998) Reliability of physical examination items used for classification of patients with low back pain. Phys Ther 78(9):979–88PubMedGoogle Scholar
  33. 33.
    Weishaupt D, Zanetti M, Hodler J, Boos N (1998) MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiology 209(3):661–666PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Per Kjaer
    • 1
    Email author
  • Lars Korsholm
    • 2
  • Tom Bendix
    • 1
  • Joan S. Sorensen
    • 1
  • Charlotte Leboeuf-Yde
    • 1
  1. 1.The Back Research Center, Part of Clinical Locomotion ScienceUniversity of Southern DenmarkRingeDenmark
  2. 2.Department of StatisticsUniversity of Southern DenmarkOdenseDenmark

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