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Modic changes in endplates of lumbar vertebral bodies: prevalence and association with low back and sciatic pain among middle-aged male workers.

Kuisma M, Karppinen J, Niinimäki J, Ojala R, Haapea M, Heliövaara M, Korpelainen R, Taimela S, Natri A, Tervonen O

Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland. mari.kuisma@fimnet.fi

STUDY DESIGN: Cross-sectional comparison of self-reported low back pain (LBP) symptoms and Modic findings on magnetic resonance imaging (MRI). OBJECTIVES: To investigate associations of frequency and intensity of LBP and sciatic pain with Modic changes in a sample of middle-aged male workers with or without whole-body vibration exposure. SUMMARY OF BACKGROUND DATA: Vertebral endplate changes are bone marrow lesions visible on MRI and are assumed to be associated with degenerative intervertebral disc disease. Associations of these so-called Modic changes with clinical symptoms are controversial. Furthermore, most of these studies have been performed in selected series of patients. METHODS: A total of 228 middle-aged male workers (159 train engineers and 69 sedentary controls) from northern Finland underwent sagittal T1 and T2-weighted MRI. Both endplates of 1140 lumbar interspaces were graded for type and extent of Modic changes. Logistic regression was used to analyze associations of pain variables with Modic changes. RESULTS: Train engineers had on the average higher sciatic pain scores than the sedentary controls, but the prevalence of Modic changes was similar in both occupational groups. Altogether, 178 Modic changes in 128 subjects were recorded: 30% were type I, 66% type II, and 4% both types I and II. Eighty percent of changes occurred at L4-L5 or L5-S1. Modic changes at L5-S1 showed significant association with pain symptoms with increased frequency of LBP (odds ratio [OR] 2.28; 95% confidence interval [CI] 1.44-3.15) and sciatica episodes (OR 1.44; 95% CI 1.01-1.89), and with higher LBP visual analog scores during the past week (OR 1.36; 95% CI 1.06-1.70). Type I lesions and extensive lesions in particular were closely associated with pain. CONCLUSIONS: Modic changes at L5-S1 and Modic type I lesions are more likely to be associated with pain symptoms than other types of Modic changes or changes located at other lumbar levels.

Published 1 May 2007 in Spine, 32(10): 1116-22.
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