Skip to main content

Advertisement

SpringerLink
Log in

Inflammatory pain pattern and pain with lumbar extension associated with Modic 1 changes on MRI: a prospective case–control study of 120 patients

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

Abstract

Purpose

To compare, in a case–control study, clinical characteristics of patients with low back pain (LBP) with and without Modic 1 signal changes on MRI.

Methods

Patients with chronic non-specific LBP and a recent (<6 months) MRI were prospectively screened and included in Modic 1 group or control group. Patients in control group were age- and gender-matched with patients with Modic 1 group. Pain characteristics, including night pain and worse pain on waking and morning stiffness, were recorded. The presence of at least one of these three characteristics indicated an inflammatory pain pattern. Patients were evaluated by questionnaires and physical examination (including lumbar range of motion). Data were analyzed by univariate and multivariate analyses.

Results

120 patients were included (60 in each group). The groups did not differ in sedentary work (p = 0.25), morning stiffness for >60 min (p = 0.19), waking at night (p = 0.08), worse pain on waking (p = 0.09), back stiffness (p = 0.12), or pain with flexion (p = 0.87). Modic 1 patients more frequently exhibited an inflammatory pain pattern (p = 0.006), worse pain with lumbar extension (p < 0.005) and responded better to oral steroids (p = 0.004) than did controls. On multivariate analysis, Modic 1 changes were associated with sedentary work [odds ratio 0.22 (95 % confidence interval 0.05–0.93)], pain with lumbar extension [11.2 (3.1–40.4)] and an inflammatory pain pattern [4.5 (1.2–16.9)].

Conclusions

Characteristics of patients with LBP and Modic 1 changes on MRI consist of an inflammatory pain pattern and pain with lumbar extension.

Level of evidence 3b.

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

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. Am J Roentgenol 149(3):531–534

    Article  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(1 Pt 1):193–199

    CAS  PubMed  Google Scholar 

  3. Modic MT, Masaryk TJ, Ross JS, Carter JR (1988) Imaging of degenerative disk disease. Radiology 168(1):177–186

    CAS  PubMed  Google Scholar 

  4. 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):661–666

    CAS  PubMed  Google Scholar 

  5. Kjaer P, Korsholm L, Bendix T, Sorensen JS, Leboeuf-Yde C (2006) Modic changes and their associations with clinical findings. Eur Spine J 15(9):1312–1319. doi:10.1007/s00586-006-0185-x

    Article  PubMed Central  PubMed  Google Scholar 

  6. 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(2):361–368. doi:10.1016/j.mehy.2007.05.014

    CAS  PubMed  Google Scholar 

  7. Ohtori S, Inoue G, Ito T, Koshi T, Ozawa T, Doya H, Saito T, Moriya H, Takahashi K (2006) 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 (Phila Pa 1976) 31(9):1026–1031. doi:10.1097/01.brs.0000215027.87102.7c

    Article  Google Scholar 

  8. Rannou F, Ouanes W, Boutron I, Lovisi B, Fayad F, Mace Y, Borderie D, Guerini H, Poiraudeau S, Revel M (2007) High-sensitivity C-reactive protein in chronic low back pain with vertebral end-plate Modic signal changes. Arthr Rheum 57(7):1311–1315. doi:10.1002/art.22985

    Article  CAS  Google Scholar 

  9. 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(4):697–707. doi:10.1007/s00586-013-2675-y

    Article  PubMed  Google Scholar 

  10. Marty M, Blotman F, Avouac B, Rozenberg S, Valat JP (1998) Validation of the French version of the Dallas Pain Questionnaire in chronic low back pain patients. Rev Rhum Engl Ed 65(2):126–134

    CAS  PubMed  Google Scholar 

  11. Sieper J, van der Heijde D, Landewe R et al (2009) New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS). Ann Rheum Dis 68(6):784–788. doi:10.1136/ard.2008.101501

    Article  CAS  PubMed  Google Scholar 

  12. Walker BF, Williamson OD (2009) Mechanical or inflammatory low back pain. What are the potential signs and symptoms? Man Ther 14(3):314–320. doi:10.1016/j.math.2008.04.003

    Article  PubMed  Google Scholar 

  13. Rudwaleit M, Braun J, Sieper J, Assessment of Spondyloarthritis international S (2009) ASAS classification criteria for axial spondyloarthritis. Z Rheumatol 68(7):591–593. doi:10.1007/s00393-009-0510-y

    Article  CAS  PubMed  Google Scholar 

  14. Calin A, Porta J, Fries JF, Schurman DJ (1977) Clinical history as a screening test for ankylosing spondylitis. JAMA 237(24):2613–2614

    Article  CAS  PubMed  Google Scholar 

  15. Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A, Cats A, Dijkmans B, Olivieri I, Pasero G et al (1991) The European Spondyloarthropathy Study Group preliminary criteria for the classification of spondyloarthropathy. Arthr Rheum 34(10):1218–1227

    Article  CAS  Google Scholar 

  16. van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthr Rheum 27(4):361–368

    Article  Google Scholar 

  17. Amor B, Dougados M, Mijiyawa M (1990) Criteria of the classification of spondyloarthropathies. Revue du rhumatisme et des maladies osteo-articulaires 57(2):85–89

    CAS  PubMed  Google Scholar 

  18. Rudwaleit M, Metter A, Listing J, Sieper J, Braun J (2006) Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria. Arthr Rheum 54(2):569–578. doi:10.1002/art.21619

    Article  Google Scholar 

  19. Maigne JY, Balard M (2004) Y a t’il des signes spécifiques de discopathie inflammatoire lombaire? Revue de Médecine Vertébrale 13:12–14

    Google Scholar 

  20. Jensen RK, Leboeuf-Yde C, Wedderkopp N, Sorensen JS, Manniche C (2012) Rest versus exercise as treatment for patients with low back pain and Modic changes. A randomized controlled clinical trial. BMC Med 10:22. doi:10.1186/1741-7015-10-22

    Article  PubMed Central  PubMed  Google Scholar 

  21. Cao P, Jiang L, Zhuang C, Yang Y, Zhang Z, Chen W, Zheng T (2011) Intradiscal injection therapy for degenerative chronic discogenic low back pain with end plate Modic changes. Spine J 11(2):100–106. doi:10.1016/j.spinee.2010.07.001

    Article  PubMed  Google Scholar 

  22. Beaudreuil J, Dieude P, Poiraudeau S, Revel M (2012) Disabling chronic low back pain with Modic type 1 MRI signal: acute reduction in pain with intradiscal corticotherapy. Ann Phys Rehabil Med 55(3):139–147. doi:10.1016/j.rehab.2012.01.004

    CAS  PubMed  Google Scholar 

  23. Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J, Sieper J (2009) The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 68(6):777–783. doi:10.1136/ard.2009.108233

    Article  CAS  PubMed  Google Scholar 

  24. Nguyen C, Bendeddouche I, Sanchez K, Jousse M, Papelard A, Feydy A, Revel M, Poiraudeau S, Rannou F (2010) Assessment of ankylosing spondylitis criteria in patients with chronic low back pain and vertebral endplate Modic 1 signal changes. J Rheumatol 37(11):2334–2339. doi:10.3899/jrheum.100165

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Rheumatology, Groupe Hospitalier Pitié-Salpétrière, Paris, France

    F. Bailly, F. Gandjbakhch, S. Rozenberg & V. Foltz

  2. Department of Physical Medicine, Hôtel-Dieu, Paris, France

    J.-Y. Maigne

  3. Division of Rheumatology, Hôpital Universitaire de Genève, Geneva, Switzerland

    S. Genevay

  4. Department of Rheumatology, Hôpital Henri-Mondor, Créteil, France

    M. Marty

  5. Spine Section of the French Society of Rheumatology, Paris, France

    F. Bailly, J.-Y. Maigne, S. Genevay, M. Marty, S. Rozenberg & V. Foltz

Authors
  1. F. Bailly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J.-Y. Maigne
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Genevay
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Marty
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. Gandjbakhch
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Rozenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. V. Foltz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Bailly.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bailly, F., Maigne, JY., Genevay, S. et al. Inflammatory pain pattern and pain with lumbar extension associated with Modic 1 changes on MRI: a prospective case–control study of 120 patients. Eur Spine J 23, 493–497 (2014). https://doi.org/10.1007/s00586-013-3036-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-013-3036-6

Keywords

Search

Navigation