Skip to main content
SpringerLink
Log in

The location of Modic changes in the lumbar spine: a meta-analysis

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

Abstract

Purpose

This meta-analysis was to study the location of Modic changes in the lumbar spine.

Methods

The electronic databases including MEDLINE, Web of science, Cochrane Central Register of Controlled Trials, OVID, CBM were searched. Relevant studies that described the patients with Modic Changes were included. Data were extracted and analysed using the version 12.0 STATA software.

Results

Thirty-one studies were selected and analyzed (2346 total patients). No significant differences of the incidence of MC were identified between superior and the inferior end plates adjacent to discs [RR = 1.04, 95 % CI (0.74, 1.53)], the same result was detected for the distribution of MC type I between L4/5 and L5/S1 [RR = 0.80, 95 % CI (0.64, 1.02)]. While lower lumbar spine (L4/5, L5/S1) had significant greater incidence of MC [RR = 0.20, 95 % CI (0.15, 0.25)], especially in L5/S1 [RR = 0.82, 95 % CI (0.72, 0.92)]. For MC type II, it also significantly appeared in L5/S1 [RR = 0.80, 95 % CI (0.67, 0.95), P = 0.010].

Conclusions

In this study, Modic Changes was more common in the lowest two levels, especially in L5/S1. Additionally, the sub-types (type I and type II) were also more likely to appear in L5/S1. It appeared that there existed a correlation between MC and biomechanics. And it seemed that local biomechanical stress might contributed to the distribution of MC and the conversion of type I to type II for the patients treated conservatively.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. de Roos A, Kressel H, Spritzer C, Dalinka M (1987) MR imaging of marrow changes adjacent to end plates in degenerative lumbar disk disease. AJR Am J Roentgenol 149:531–534

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  3. Jensen TS, Sorensen JS, Kjaer P (2007) Intra- and interobserver reproducibility of vertebral endplate signal (modic) changes in the lumbar spine: the Nordic Modic Consensus Group classification. Acta Radiol 48:748–754. doi:10.1080/02841850701422112

    Article  CAS  PubMed  Google Scholar 

  4. Vital JM, Gille O, Pointillart V, Pedram M, Bacon P, Razanabola F, Schaelderle C, Azzouz S (2003) Course of Modic 1 six months after lumbar posterior osteosynthesis. Spine 28:715–721

    CAS  PubMed  Google Scholar 

  5. Toyone T, Takahashi K, Kitahara H, Yamagata M, Murakami M, Moriya H (1994) Vertebral bone-marrow changes in degenerative lumbar disc disease: an MRI study of 74 patients with low back pain. J Bone Joint Surg 76:757–764

    CAS  Google Scholar 

  6. Albert HB, Lambert P, Rollason J, Sorensen JS, Worthington T, Pedersen MB, Nørgaard HS, Vernallis A, Busch F, Manniche C, Elliott T (2013) Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae? Eur Spine J 22:690–696. doi:10.1007/s00586-013-2674-z

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ma XL, Ma JX, Wang T, Tian P, Han C (2011) Possible role of autoimmune reaction in Modic Type I changes. Med Hypotheses 76:692–694. doi:10.1016/j.mehy.2011.01.035

    Article  PubMed  Google Scholar 

  8. Albert HB, Kjaer P, Jensen TS, Sorensen JS, Bendix T, Manniche C (2008) Modic changes, possible causes and relation to low back pain. Med Hypotheses 70:361–368. doi:10.1016/j.mehy.2007.05.014/c

    Article  CAS  PubMed  Google Scholar 

  9. Modic MT (2007) Modic type 1 and type 2 changes. J Neurosurg Spine 6:150–151

    Article  PubMed  Google Scholar 

  10. Grant JP, Oxland TR, Dvorak MF (2001) Mapping the structural properties of the lumbosacral vertebral endplates. Spine 26:889–896

    Article  CAS  PubMed  Google Scholar 

  11. Li ZG, Zheng LJ, Li GC, Chen XZ, Xia CJ (2007) Biomechanical research on the properties of the lumbosacral endplates. Chin J Spine Spinal Cord 17:210–213

    Google Scholar 

  12. Fardon DF, Milette PC (2001) Nomenclature and classification of lumbar disc pathology. Spine 26:E93–E113

    Article  CAS  PubMed  Google Scholar 

  13. Bendix T, Sorensen JS, Henriksson GA, Bolstad JE, Narvestad EK, Jensen TS (2012) Lumbar modic changes-a comparison between findings at low- and high-field magnetic resonance imaging. Spine 37:1756–1762. doi:10.1097/BRS.0b013e318257ffce

    Article  PubMed  Google Scholar 

  14. Kuisma M, Karppinen J, Niinimäki J, Ojala R, Haapea M, Heliovaara M, Korpelainen R, Taimela S, Natri A, Tervonen O (2007) Modic changes in endplates of lumbar vertebral bodies: prevalence and association with low back and sciatic pain among middle-aged male workers. Spine 32:1116–1122

    Article  PubMed  Google Scholar 

  15. Wang Y, Videman T, Battie MC (2012) Modic changes: prevalence, distribution patterns, and association with age in white men. Spine J 12:411–416. doi:10.1016/j.spinee.2012.03.026

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Fayad F, Lefevre-Colau MM, Drape JL, Feydy A, Chemla N, Quinte N, Rannou F, Poiraudeau S, Fermanian J, Revel M (2009) Reliability of a modified Modic classification of bone marrow changes in lumbar spine MRI. Joint Bone Spine 76:286–289. doi:10.1016/j.jbspin.2008.09.012

    Article  PubMed  Google Scholar 

  17. Jones A, Clarke A, Freeman BJC, Lam KS, Grevitt MP (2005) The Modic classification: inter- and intraobserver error in clinical practice. Spine 30:1867–1869

    Article  PubMed  Google Scholar 

  18. Lu BJ (2008) Low back pain patients in the lumbar intervertebrai disc degeneration and related factors of change Modic. Xuzhou Medical College, Xuzhou

    Google Scholar 

  19. Peterson CK, Gatterman B, Carter JC, Humphreys BK, Weibel A (2007) Inter- and intraexaminer reliability in identifying and classifying degenerative marrow (Modic) changes on lumbar spine magnetic resonance scans. J Manipulative Physiol Ther 30:85–90. doi:10.1016/j.jmpt.2006.12.001

    Article  PubMed  Google Scholar 

  20. Karppinen J, Solovieva S, Luoma K, Raininko R, Leino-Arjas P, Riihimaki H (2009) Modic changes and interleukin 1 gene locus polymorphisms in occupational cohort of middle-aged men. Eur Spine J 18:1963–1970. doi:10.1007/s00586-009-1139-x

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wang F (2007) Endplate cells apoptosis in lumbar disc degeneration and the protect of CTGF in vitro. Southern Medical University, Guangzhou

    Google Scholar 

  22. Zhang R, Yin BS, Yang Q, Yang LY, Wang SN (2012) Distribution of Modic changes of lumbar endplate in patients suffering from low back pain or radiculopathy and its related factors. J Dali Med Univ 34:161–165

    Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  24. Zhang XD, Wang GZ, Zhuang RJ (2014) Correlation research on the MRI quantity of lumbar Modic changes and low back pain. Chin J Orthop Trauma 27:213–216

    CAS  Google Scholar 

  25. Braithwaite I, White J, Saifuddin A, Renton P, Taylor BA (1998) Vertebral end-plate (Modic) changes on lumbar spine MRI correlation with pain reproduction at lumbar discography. Eur Spine J 7:363–368

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Briggs AM, O’Sullivan PB, Briggs AM, Foulner D, Wark JD (2012) Vertebral bone mineral measures and psychological wellbeing among individuals with modic changes. Clin Med Insights Case Rep 5:35–41. doi:10.4137/CCRep.S9209

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kleinstück F, Dvorak J, Mannion AF (2006) Are structural abnormalities on magnetic resonance imaging a contraindication to the successful conservative treatment of chronic nonspecific low back pain. Spine 31:2250–2257

    Article  PubMed  Google Scholar 

  28. Chung CB, Vande Berg BC, Tavernier T, Cotten A, Laredo JD, Vallee C, Malghem J (2004) End plate marrow changes in the asymptomatic lumbosacral spine: frequency, distribution and correlation with age and degenerative changes. Skeletal Radiol 33:399–404. doi:10.1007/s00256-004-0780-z

    Article  PubMed  Google Scholar 

  29. Wilkens P, Storheim K, Scheel I, Berg L, Espeland A (2012) No effect of 6-month intake of glucosamine sulfate on Modic changes or high intensity zones in the lumbar spine: sub-group analysis of a randomized controlled trial. J Negat Results Biomed 11:13. doi:10.1186/1477-5751-11-13

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kuisma M, Karppinen J, Niinimäki J, Kurunlahti M, Haapea M, Vanharanta H, Tervonen O (2006) A 3-year follow-up of lumbar spine endplate (Modic) changes. Spine 31:1714–1718

    Article  PubMed  Google Scholar 

  32. Koivisto K, Kyllonen E, Haapea M, Niinimäki J, Sundqvist K, Pehkonen T, Seitsalo S, Tervonen O, Karppinen J (2014) Efficacy of zoledronic acid for chronic low back pain associated with Modic changes in magnetic resonance imaging. BMC Musculoskelet Disord 15:64. doi:10.1186/1471-2474-15-64

    Article  PubMed  PubMed Central  Google Scholar 

  33. Han C, Ma XL, Ma JX, Wang T, Tian P, Zang JC (2011) Correlative factors for MRI signal changes of lumbar endplate, a correlation study between sex, weight, quantity of work, smoking and Modic changes. Chin J Spine Spinal Cord 21:222–225

    Google Scholar 

  34. Yang YQ, Cao P, Pan YT, Liang Y, Gong YC, Zheng T, Zhang XK, Wu WJ (2009) Selection of surgical methods for lumbar disc herniation with degenerative endplates changes. Natl Med J China 89:1902–1906

    Google Scholar 

  35. Shan Z, Fan SW, Xie QB, Suyou L, Liu JH, Wang CY, Zhao FD (2014) Spontaneous resorption of lumbar disc herniation is less likely when modic changes are present. Spine 39:736–744. doi:10.1097/BRS.0000000000000259

    Article  PubMed  Google Scholar 

  36. Kuisma M, Karppinen J, Haapea M, Lammentausta E, Niinimäki J, Tervonen O (2009) Modic changes in vertebral endplates: a comparison of MR imaging and multislice CT. Skeletal Radiol 38:141–147. doi:10.1007/s00256-008-0590-9

    Article  PubMed  Google Scholar 

  37. He X, Peng Y, Liang AJ, Zhang XL, Huang DS (2012) Prevalence and value of Modic change and high-intensity zone on MRI in lower lumbar spine of patients with low back pain. Chin J Spine Spinal Cord 22:407–411

    Google Scholar 

  38. Zhu JZ, Qin J, Xu LC (2010) Study on vertebral endplate signal changes (modic changes): value of MRI in detecting endplate sclerosis of lumbar spine. Radiol Pratice 25:793–795

    Google Scholar 

  39. Kaapa E, Luoma K, Pitkaniemi J, Kerttula L, Grönblad M (2012) Correlation of size and type of modic types 1 and 2 lesions with clinical symptoms: a descriptive study in a subgroup of patients with chronic low back pain on the basis of a university hospital patient sample. Spine 37:134–139. doi:10.1097/BRS.0b013e3182188a90

    Article  PubMed  Google Scholar 

  40. Li W, Zhan WW, Fen Y, Liu Y (2013) The diagnosis character of Modic type I in endplate degeneration under high field MRI the journal of traditional Chinese. Orthoped Traumatol 25:33–34

    Google Scholar 

  41. Albert HB, Pedersen H, Manniche C, Høilund-Carlsen PF (2009) PET imaging in patients with Modic changes. Nuklearmedizin Nucl Med 48:110–112. doi:10.3413/nukmed-0202

    Google Scholar 

  42. Masala S, Anselmetti GC, Marcia S, Nano G, Taglieri A, Calabria E, Chiocchi M, Simonetti G (2014) Treatment of painful Modic type I changes by vertebral augmentation with bioactive resorbable bone cement. Neuroradiology 56:637–645. doi:10.1007/s00234-014-1372-9

    Article  PubMed  Google Scholar 

  43. White Iii AA, Gordon SL (1982) Synopsis: workshop on idiopathic low-back pain. Spine 7:141–149

    Article  Google Scholar 

  44. Broberg KB (1983) On the mechanical behaviour of intervertebral discs. Spine 8:151–165

    Article  CAS  PubMed  Google Scholar 

  45. Hansson T, Roos B (1981) Microcalluses of the trabeculae in lumbar vertebrae and their relation to the bone mineral content. Spine 6:375–380

    Article  CAS  PubMed  Google Scholar 

  46. Adams MA (2004) Biomechanics of back pain. Acupunct Med 22:178–188

    Article  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  48. Karchevsky M, Schweitzer ME, Carrino JA, Zoga A, Montgomery D, Parker L (2005) Reactive endplate marrow changes: a systematic morphologic and epidemiologic evaluation. Skeletal Radiol 34:125–129. doi:10.1007/s00256-004-0886-3

    Article  PubMed  Google Scholar 

  49. Jensen TS, Bendix T, Sorensen JS, Manniche C, Korsholm L, Kjaer P (2009) Characteristics and natural course of vertebral endplate signal (Modic) changes in the Danish general population. BMC Musculoskelet Disord 10:81. doi:10.1186/1471-2474-10-81

    Article  PubMed  PubMed Central  Google Scholar 

  50. Hongo M, Abe E, Shimada Y, Murai H, Ishikawa N, Sato K (1999) Surface strain distribution on thoracic and lumbar vertebrae under axial compression. The role in burst fractures. Spine 24:1197–1202

    Article  CAS  PubMed  Google Scholar 

  51. Hilton RC, Ball J (1984) Vertebral rim lesions in the dorsolumbar spine. Ann Rheum Dis 43:302–307

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Holmes AD, Hukins DWL, Freemont AJ (1993) End-plate displacement during compression of lumbar vertebra-disc-vertebra segments and the mechanism of failure. Spine 18:128–135

    Article  CAS  PubMed  Google Scholar 

  53. Roberts S, McCall IW, Menage J, Haddaway MJ, Eisenstein SM (1997) Does the thickness of the vertebral subchondral bone reflect the composition of the intervertebral disc. Eur Spine J 6:385–389

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Wang Y, Battie MC, Boyd SK, Videman T (2011) The osseous endplates in lumbar vertebrae: thickness, bone mineral density and their associations with age and disk degeneration. Bone 48:804–809. doi:10.1016/j.bone.2010.12.005

    Article  PubMed  Google Scholar 

  55. Elfering A, Semmer N, Birkhofer D, Zanetti M, Hodler J, Boos N (2002) Risk factors for lumbar disc degeneration: a 5-year prospective MRI study in asymptomatic individuals. Spine 27:125–134

    Article  PubMed  Google Scholar 

  56. He X, Liang AJ, Gao WJ, Peng Y, Zhang LM, Liang GY, Huang DS (2012) The relationship between concave angle of vertebral endplate and lumbar intervertebral disc degeneration. Spine 37:E1068–E1073. doi:10.1097/BRS.0b013e31825640eb

    Article  PubMed  Google Scholar 

  57. Luoma K, Vehmas T, Riihimäki H, Raininko R (2001) Disc height and signal intensity of the nucleus pulposus on magnetic resonance imaging as indicators of lumbar disc degeneration. Spine 26:680–686

    Article  CAS  PubMed  Google Scholar 

  58. Savage RA, Whitehouse GH, Roberts N (1997) The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males. Eur Spine J 6:106–114

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Poureisa M, Daghighi MH, Mesbahi S, Hagigi A, Fouladi DF (2014) End plate disproportion and degenerative disc disease: a case–control study. Asian spine journal 8:405–411. doi:10.4184/asj.2014.8.4.405

    Article  PubMed  PubMed Central  Google Scholar 

  60. Schwarzer AC, Derby R, Aprill CN, Fortin J, Kine G, Bogduk N (1994) Pain from the lumbar zygapophysial joints: a test of two models. J Spinal Disord 7:331–336

    Article  CAS  PubMed  Google Scholar 

  61. Manchikanti L, Pampati V, Fellows B, Baha AG (2000) The inability of the clinical picture to characterize pain from facet joints. Pain Physician 3:158–166

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The manuscript submitted does not contain information about medical drug(s). This work was supported by the Department of Health of Zhejiang Province, Backbone of Talent Project (2012RCB037); and the Department of Science and Technology of Wenzhou, Wenzhou Science and Technology Project (Y20120073). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. The Department of Orthopedics Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109# XueYuan Western Road, Wenzhou, 325027, Zhejiang, People’s Republic of China

    Zhe-Yu Huang, Hai-Chao Xu, Tao Lei, Qing-Long Li, Ai-Min Wu & Wen-Fei Ni

Authors
  1. Zhe-Yu Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hai-Chao Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tao Lei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Qing-Long Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ai-Min Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wen-Fei Ni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wen-Fei Ni.

Ethics declarations

Conflict of interest

The authors certify that there is no actual or potential conflict of interest in relation to this article.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huang, ZY., Xu, HC., Lei, T. et al. The location of Modic changes in the lumbar spine: a meta-analysis. Eur Spine J 25, 3746–3759 (2016). https://doi.org/10.1007/s00586-016-4456-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-016-4456-x

Keywords

Search

Navigation