• Florence P S Mok, Dino Samartzis, Jaro Karppinen, Daniel Y T Fong, Keith D K Luk, and Kenneth M C Cheung.
• Department of Orthopaedics & Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China.
• Spine J. 2016 Jan 1; 16 (1): 32-41.

Background ContextModic changes (MC) are bone marrow lesions on magnetic resonance imaging (MRI), suggestive of being associated with low back pain (LBP). Data on determinants of MC and their association with disc degeneration and other spinal phenotypes, as well as that of LBP, rely mostly on small-scale patient populations and remain controversial.PurposeThis study addressed the potential determinants of MC and their association with disc degeneration and LBP among Southern Chinese.Study Design/SettingA cross-sectional, population-based study was carried out.Patient SampleThis study consisted of 2,449 Southern Chinese volunteers.MethodsSagittal T2-weighted MRIs of the lumbar spine were assessed for the presence of MC and other spinal phenotypes (eg, disc degeneration, disc displacement, Schmorl nodes) in all individuals. Subjects' demographics, occupation, lifestyle, and clinical profiles were assessed.ResultsThe overall prevalence of MC was 5.8% (n=141), which increased with advancing age. Modic changes predominantly occurred at the lowest two lumbar levels (83%). In the multivariate analyses, only the presence of disc displacement and a higher disc degeneration score were associated with MC at the upper lumbar levels (L1/L2-L3/L4) (p<.01). The presence of MC at the lowest two lumbar levels (L4/L5-L5/S1) were associated with age, the presence of Schmorl nodes, disc degeneration or displacement, and historical lumbar injury (p<.01). Subjects who were both smokers and overweight or obese had increased likelihood of MC in the lower spine (OR: 2.18; 95% CI: 1.10-4.30). The presence of MC at the lower lumbar levels were associated with historical LBP (OR: 1.93; 95% CI: 1.05-3.54) and with severity and duration of symptoms (p<.05).ConclusionsBased on one of the largest MRI studies to assess lumbar MC, we noted that MC were associated with both disc degeneration and the presence and severity of LBP. Determinants and association of MC with disc degeneration and clinical symptoms in the upper versus the lower lumbar spine were different. Our study further stresses the significance of MC as important imaging phenotypes associated with LBP.Copyright © 2015 Elsevier Inc. All rights reserved.

21 keywords...

hide…