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Degenerative Marrow Changes: Natural History Biomechanics in Relation to Symptoms

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Advanced Concepts in Lumbar Degenerative Disk Disease

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Abstract

Signal intensity changes of the vertebral body marrow adjacent to the end plates of degenerated disks are a long recognized and common observation on MR images of the lumbar spine [1, 2]. However, despite a growing body of literature on this subject, their clinical importance, etiology, and relationship to symptoms remain unclear [3].

Editor’s Note

Dr. Modic gave us the great honor of a chapter written by himself about the radiological findings that were marked in medicine as Modic changes. We are very grateful to him for his current appraisal of the matter.

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References

  1. DeRoss A, Kressel H, Spritzer C, et al. MR imaging of marrow changes adjacent to end plates in degenerative lumbar disc disease. AJR Am J Roentgenol. 1987;149:531–4.

    Article  Google Scholar 

  2. Modic MT, Steinbert PM, Ross JS, et al. Degenerative disc disease; assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988;166:193–9.

    Article  CAS  PubMed  Google Scholar 

  3. Rahme R, Moussa R. The Modic vertebral endplate and marrow changes: pathologic significance and relation to low back pain and segmental instability of the lumbar spine. AJNR. 2008;29:838–42.

    Article  CAS  PubMed  Google Scholar 

  4. Ross JS, Obuchowski N, Zepp R. The postoperative lumbar spine: evaluation of epidural scar over a 1-year period. AJNR Am J Neuroradiol. 1998;19:183–6.

    CAS  PubMed  Google Scholar 

  5. Masaryk TJ, Boumphrey F, Modic MT, Tamborrello C, Ross JS, Brown MD. Effects of chemonucleolysis demonstrated by MR imaging. J Comput Assist Tomogr. 1986;10:917–23.

    Article  CAS  PubMed  Google Scholar 

  6. Modic MT, Masary TJ, Ross JS, et al. Imaging of degenerative disk disease. Radiology. 1988;168:177–86.

    Article  CAS  PubMed  Google Scholar 

  7. Ulmer JL, Elster AD, Mathews VP, Allen AM. Lumbar spondylolysis: reactive marrow changes seen in adjacent pedicles on MR images. AJR Am J Roentgenol. 1995;164:429–33.

    Article  CAS  PubMed  Google Scholar 

  8. Morrison JL, Kaplan PA, Dussault RG, Anderson MW. Pedicle marrow signal intensity changes in the lumbar spine: a manifestation of facet degenerative joint disease. Skelet Radiol. 2000;29:703–7.

    Article  CAS  Google Scholar 

  9. Chamay A, Tshants P. Mechanical influence in bone remodeling: experimental research on Wolff’s law. J Biomech. 1972;5:173–80.

    Article  CAS  PubMed  Google Scholar 

  10. Schweitzer ME. Does altered biomechanics cause marrow edema? Radiology. 1996;198(3):851–3.

    Article  CAS  PubMed  Google Scholar 

  11. Carter DR. Mechanical loading histories and cortical bone remodeling. Calcif Tissue Int. 1984;36:19–24.

    Article  Google Scholar 

  12. Roub LW, Gumerman LW, Hanley Jr EN, Clar MW, Goodman M, Herbert DL. Bone stress: a radionuclide imaging perspective. Radiology. 1979;132:431–8.

    Article  CAS  PubMed  Google Scholar 

  13. Toyone T, Takahashi K, Kitahara H, et al. Vertebral bone marrow changes in degenerative lumbar disc disease: an MRI study of 74 patients with low back pain. J Bone Joint Surg (Br). 1994;76:757–64.

    CAS  Google Scholar 

  14. Mitra D, Cassar-Pullicino VN, McCall IW. Longitudinal study of vertebral type-1 end-plate changes on MR of the lumbar spine. Eur Radiol. 2004;14:1574–81.

    Article  CAS  PubMed  Google Scholar 

  15. Kuisma M, et al. A three-year follow up of lumbar spine endplate (Modic) changes. Spine. 2006;31(15):1714–8.

    Article  PubMed  Google Scholar 

  16. Albert HB, Manniche C. Modic changes following lumbar disc herniation. Eur Spine J. 2007;16:977–82.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Modic MT. Modic type I and type 2 changes. J Neurosurg Spine. 2007;6:150–1.

    Article  PubMed  Google Scholar 

  18. Braithwaite I, White J, Saifuddin A, Renton P, Taylor BA. Vertebral end-plate (Modic) changes on lumbar spine MRI: correlation with pain reproduction at lumbar discography. Eur Spine J. 1998;7:363–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Weishaupt D, Zanetti M, Hodler J, et al. Painful lumbar disk derangement: relevance of endplate abnormalities at MR imaging. Radiology. 2001;218:420–7.

    Article  CAS  PubMed  Google Scholar 

  20. Sandhu HS, Sanchez-Caso LP, Parvataneni HK, Cammisa Jr FP, Girardi FP, Ghelman B. Association between findings of provocative discography and vertebral endplate signal changes as seen on MRI. J Spinal Disord. 2000;13:438–43.

    Article  CAS  PubMed  Google Scholar 

  21. Burke JG, Watson RW, McCormack D, et al. Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. J Bone Joint Surg (Br). 2002;84:196–201.

    Article  CAS  Google Scholar 

  22. Karchevsky M, Schweitzer ME, Carrino JA, et al. Reactive endplate marrow changes: a systematic morphologic and epidemiologic evaluation. Skelet Radiol. 2005;34:125–9.

    Article  Google Scholar 

  23. Boos N, Weissbach S, Rohrbach H, et al. Classification of age-related changes in lumbar intervertebral discs: 2002 Volvo award in basic science. Spine. 2002;27:2631–44.

    Article  PubMed  Google Scholar 

  24. Marshman LA, Trewhella M, Friesem T, et al. Reverse transformation of Modic type II changes to Modic type I changes during sustained chronic low-back pain severity; report of two cases and review of the literature. J Neurosurg Spine. 2007;6:152–5.

    Article  PubMed  Google Scholar 

  25. Jensen TS. Quality of like in low back pain patients with MRI-lesions in spinal bone marrow and vertebral endplates (Modic-changes): clinical significant for outcome of spinal surgery? Scand J Pain. 2014;5:34–5.

    Article  Google Scholar 

  26. Määttä J, et al. Association of Modic changes with health-related quality of life among patients referred to spine surgery. Scand J Pain. 2014;5:36–40.

    Article  Google Scholar 

  27. Chataigner H, Onimus M, Polette A. Surgery for degenerative lumbar disc disease: should the black disc be grafted (in French)? Rev Chir Orthop Reparatrice Appar Mot. 1998;84:583–9.

    CAS  PubMed  Google Scholar 

  28. Buttermann GR, Heithoff KB, Ogilvie JW, et al. Vertebral body MRI related to lumbar fusion results. Eur Spine J. 1997;6:115–20.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  29. Esposito P, Pinheiro-Franco JL, Froelich S, et al. Predictive value of MRI vertebral end-plate signal changes (Modic) on outcome of surgically treated degenerative disc disease: results of a cohort study including 60 patients. Neurochirurgie. 2006;52:315–22.

    Article  PubMed  Google Scholar 

  30. Vital JM, Gille O, Pointillart V, et al. Course of Modic 1 6 months after lumbar posterior osteosynthesis. Spine. 2003;28:715–20.

    CAS  PubMed  Google Scholar 

  31. Borg B, Modic M, Ash L, Ross J, Hatem S, Obuchowski N. MR pedicle marrow signal abnormalities. In: RSNA Proceedings, November 22– December 2, Chicago. Oak Brook, IL: RSNA, 2005 (Abstract SSC12–03).

    Google Scholar 

  32. Albert H, et al. Modic changes, possible causes and relation to low back pain. Med Hypotheses. 2008;70:361–8.

    Article  CAS  PubMed  Google Scholar 

  33. Ohtori S, Inoue G, Ito T, et al. Tumor necrosis factor-immunoreactive cells and PGP 9.5-immunoreactive nerve fibers in vertebral endplates of patients with discogenic low back pain and Modic type 1 or type 2 changes on MRI. Spine. 2006;31:1026–31.

    Article  PubMed  Google Scholar 

  34. Korhonen T, Karppinen J, Paimela L, et al. The treatment of disc-herniation induced sciatica with infliximab: one year follow-up results of FIRST II, a randomized controlled trial. Spine. 2006;31:2759–66.

    Article  PubMed  Google Scholar 

  35. Ross JS, Modic MT. Current assessment of spinal degenerative disc disease with magnetic resonance imaging. Clin Orthop Relat Res. 1992;279:68–81.

    PubMed  Google Scholar 

  36. Albert H, et al. Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized controlled trial of efficacy. Eur Spine J. 2013;22:697–707.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Stirling AJ, et al. Association between sciatica and propionibacterium acnes. Lancet. 2001;357:2024–5.

    Article  CAS  PubMed  Google Scholar 

  38. Albert H, et al. Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae? Eur Spine J. 2013;22(4):690–6.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Stirling AJ, Jiggins M. Association between sciatica and skin commensals. Cleveland: International Society for the Study of the Lumbar Spine; 2002.

    Google Scholar 

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Authors and Affiliations

  1. Cleveland Clinic, Neurological Institute, 9500 Euclid Ave., NA4, Cleveland, OH, 44195, USA

    Michael T. Modic MD, FACR

Authors
  1. Michael T. Modic MD, FACR
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Corresponding author

Correspondence to Michael T. Modic MD, FACR .

Editor information

Editors and Affiliations

  1. Neurological and Spine Surgery, Hospital Samaritano, São Paulo, São Paulo, Brazil

    João Luiz Pinheiro-Franco

  2. Rothman Institute, Thomas Jefferson University Medical Center, Philadelphia, Pennsylvania, USA

    Alexander R. Vaccaro

  3. Cleveland Clinic Neurological Surgery, Cleveland, Ohio, USA

    Edward C. Benzel

  4. Schön Klinik München Harlaching FG Wirbelsäulenchirurgie, München, Germany

    H. Michael Mayer

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Modic, M.T. (2016). Degenerative Marrow Changes: Natural History Biomechanics in Relation to Symptoms. In: Pinheiro-Franco, J., Vaccaro, A., Benzel, E., Mayer, H. (eds) Advanced Concepts in Lumbar Degenerative Disk Disease. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-47756-4_10

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  • DOI: https://doi.org/10.1007/978-3-662-47756-4_10

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-47755-7

  • Online ISBN: 978-3-662-47756-4

  • eBook Packages: MedicineMedicine (R0)

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