• Hidenobu Tamai, Masatoshi Teraguchi, Hiroshi Hashizume, Hiroyuki Oka, CheungJason P YJPYDepartment of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China., Dino Samartzis, Shigeyuki Muraki, Toru Akune, Hiroshi Kawaguchi, Kozo Nakamura, Sakae Tanaka, Munehito Yoshida, Noriko Yoshimura, and Hiroshi Yamada.
• Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan.
• Spine. 2022 Mar 15; 47 (6): 490-497.

Study DesignLarge-scale, prospective, population-based, longitudinal observational study.ObjectiveThe aim of this study was to investigate the rate of incidence, transformation, and reverse transformation of Modic changes (MCs) using T1-weighted (T1W) and T2-weighted (T2W) lumbar magnetic resonance images (MRI) over a 3-year period.Summary Of Background DataAlthough MCs in populational study are considered significant, existing epidemiological evidence is based on cross-sectional studies only.MethodsOverall, 678 subjects (208 men, 470 women, mean age 62.1 ± 12.8 years in 2013) in both 2013 and 2016 surveys were included. The rate of change in Modic Type I (T1W: low-intensity, T2W: high-intensity), Type II (T1W: high, T2W: high), and Type III (T1W: low, T2W: low) at five endplates was analyzed over a 3-year period. An incidence of MC at each level and in the lumbar region was defined as no MC at baseline with signal changes at follow-up. Transformation was defined as Type I or II MC at baseline with conversion at follow-up Type II from Type I or Type III MC from Type I and II. Furthermore, reverse transformation was defined as Type I, II, or III MC at baseline, with at least one endplate showing a reversion in Modic type (no MC for baseline Type I; no MC and Type I for baseline Type II; no MC, Type I or Type II for baseline Type III) at follow-up.ResultsOverall, 3390 endplates were included. For 3 years, the incidence, transformation, and reverse transformation of MCs were seen in 395 (11.7%), 84 (2.5%), and 11 (0.3%) endplates, respectively. The highest levels of incidence, transformation, and reverse transformation were at L2/3 (96 [14.2%] endplates), L5/S1 (32 [4.7%] endplates), and L2/3 (5 [0.7%] endplates), respectively.ConclusionThis study revealed a high incidence of MCs at the upper lumbar levels and transformation at the lower lumbar levels. Reverse transformation of MCs occurs but are rare.Level of Evidence: 2.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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