• Rikke K Jensen, Charlotte Leboeuf-Yde, Niels Wedderkopp, Joan S Sorensen, Tue S Jensen, and Claus Manniche.
• Research Department, Spine Centre of Southern Denmark, Clinical Locomotion Network, Hospital Lillebaelt, Oestre Hougvej 55, 5500, Middelfart, Denmark. rikke.kruger.jensen@slb.regionsyddanmark.dk
• Eur Spine J. 2012 Nov 1;21(11):2271-9.

PurposeModic changes (MCs) have been suggested to be a diagnostic subgroup of low back pain (LBP). However, the clinical implications of MCs remain unclear. For this reason, the aims of this study were to investigate how MCs developed over a 14-month period and if changes in the size and/or the pathological type of MCs were associated with changes in clinical symptoms in a cohort of patients with persistent LBP and MCs.MethodsInformation on LBP intensity and detailed information from MRI on the presence, type and size of MCs was collected at baseline and follow-up. Changes in type (type I, II, III and mixed types) and size of MCs were quantified at both time points according to a standardised evaluation protocol. The associations between change in type, change in size and change in LBP intensity were calculated using odds ratios (ORs).ResultsApproximately 40% of the MCs followed the expected developmental path from type I (here type I or I/II) to type II (here type II or II/III) or type I to type I/II. In general, the bigger the size of the MC at baseline, the more likely it was that it remained unchanged in size after 14 months. Patients who had MC type I at both baseline and 14-month follow-up were less likely to experience an improvement in their LBP intensity as compared to patients who did not have type I changes at both time points (OR 7.2, CI 1.3-37). There was no association between change in size of MCs type I and change in LBP intensity.ConclusionsThe presence of MCs type I at both baseline and follow-up is associated with a poor outcome in patients with persistent LBP and MCs.

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