Skip to main content

Modic Changes: Anatomy, Pathophysiology and Clinical Correlation

  • Chapter
  • First Online:

Part of the book series: Acta Neurochirurgica Supplementum ((NEUROCHIRURGICA,volume 108))

Abstract

Studying discovertebral complex anatomy is extremely important for the understanding of the pathophysiology of disc degeneration which leads to vertebral endplates signal changes, also known as Modic changes.

The sequelae of disc degeneration are among the leading causes of functional incapacity in both sexes and are one of the most common sources of chronic disability in the working years. Even if the presence of degenerative changes in MRI of the spine is by no means an indicator of symptoms, we are concordant in a positive association between Modic changes and low back pain, above all as a relatively specific but insensitive sign of discogenic low back pain.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Albert HB, Manniche C (2007) Modic changes following lumbar disc herniation. Eur Spine J 16:977–982

    Article  PubMed  Google Scholar 

  2. Battie MC, Videman T, Parent E (2004) Lumbar disc degeneration: epidemiology and genetic influences. Spine 29:2679– 2690

    Article  PubMed  Google Scholar 

  3. Benneker LM et al. (2005) Vertebral marrow endplate marrow contact channel occlusion and intervertebral disc degeneration. Spine 30:167

    Article  PubMed  Google Scholar 

  4. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW (1990) Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects: a prospective investigation. J Bone Joint Surg 72:403–408

    PubMed  CAS  Google Scholar 

  5. Bogduk N, Modic MT (1996) Lumbar discography. Spine 21:402–404

    Article  PubMed  CAS  Google Scholar 

  6. Braithwaite I, White J, Saiffudin A et al. (1998) Vertebral end-plate (Modic) changes on lumbar spine MRI: correlation with pain reproduction at lumbar discography. Eur Spine J 7:363–368

    Article  PubMed  CAS  Google Scholar 

  7. Brown MF, Hukkanen MV, McCarthy ID, Redfern DR et al (1997) Sensory and sympathetic innervation of the vertebral endplate in patients with degenerative disc disease. J Bone Joint Surg Br 79:147–153

    Article  PubMed  CAS  Google Scholar 

  8. Carrino JA et al. (2009) Lumbar spine: reliability of MR imaging findings. Radiology 250:161–170

    Article  PubMed  Google Scholar 

  9. Chung CB, Vande Berg BC, Tavernier T, Cotten A et al. (2004) End plate marrow changes in the asymptomatic lumbosacral spine: frequency, distribution and correlation with age and degenerative changes. Skeletal Radiol 33:399–404

    Article  PubMed  Google Scholar 

  10. Crock HV (1986) Internal disc disruption: a challenge to disc prolapse fifty years on. Spine 11:650–653

    Article  PubMed  CAS  Google Scholar 

  11. 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 149:531–534

    Google Scholar 

  12. Deyo RA (1994) Magnetic resonance imaging of the lumbar spine – Terrific test or tar baby? N Engl J Med 331:115–116

    Article  PubMed  CAS  Google Scholar 

  13. Fagan A, Moore R, Vernon RB, Blumbergs P et al. (2003) ISSLS prize winner: the innervation of the intervertebral disc: a quantitative analysis. Spine 28:2570–2576

    Article  PubMed  Google Scholar 

  14. Fardon DF, Milette PC (2001) Nomenclature and classification of lumbar disc pathology. Recommendations of the combined task forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine 26:93–113

    Article  Google Scholar 

  15. Fayad F, Lefevre-Colau MM, Rannou F, Quintero N et al. (2007) Relation of inflammatory modic changes to intradiscal steroid injection outcome in chronic low back pain. Eur Spine J 16:925–931

    Article  PubMed  Google Scholar 

  16. Freemont AJ, Peacock TE, Goupille P, Hoyland JA et al. (1997) Nerve ingrowth into diseased intervertebral disc in chronic back pain. Lancet 350:178–181

    Article  PubMed  CAS  Google Scholar 

  17. Guyer RD, Ohnmeiss DD (1995) Contemporary concepts in lumbar discography: position statement from the North American Spine Society Diagnostic and Therapeutic Committee. Spine 18:2048–2059

    Article  Google Scholar 

  18. Hayes CW, Jensen ME, Conway WF (1989) Non-neoplastic lesions of vertebral bodies: findings in magnetic resonance imaging. Radiographics 9:883–903

    PubMed  CAS  Google Scholar 

  19. Hermann KG, Bollow M (2004) Magnetic resonance imaging of the axial skeleton in rheumatoid disease. Best Pract Res Clin Rheumatol 18:881–907

    Article  PubMed  Google Scholar 

  20. Horner HA, Urban JPG (2001) Effects of nutrient supply on the viability of cells from the nucleus pulposus of the intervertebral disc. Spine 26:2543–2549

    Article  PubMed  CAS  Google Scholar 

  21. Jensen TS, Karpinnen J, Sorensen JS et al. (2008) Vertebral end-plate signal (Modic) changes: a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J 17:1407–1422

    Article  PubMed  Google Scholar 

  22. Jensen TS, Sorensen JS, Kjaer P (2007) Intra- and interobserver reproducibility of vertebral end plate signal (modic) changes in the lumbar spine: the Nordic Modic Consensus Group classification. Acta Radiol 48:748–754

    Article  PubMed  CAS  Google Scholar 

  23. Jevtic V (2001) Magnetic resonance imaging appearances of different discovertebral lesions. Eur Radiol 11:1123–1135

    Article  PubMed  CAS  Google Scholar 

  24. Jones A, Clarke A, Freeman BJC, Lam KS , Grevitt MP (2005) The modic classificationinter- and intraobserver error in clinical practice. Spine 30:1867–1869

    Article  PubMed  Google Scholar 

  25. Karchevsky M, Schweitzer ME, Carrino JA, Zoga A et al (2005) Reactive endplate marrow changes: a systematic morphologic and epidemiologic evaluation. Skeletal Radiol 34:125–129

    Article  PubMed  Google Scholar 

  26. Kjaer P, Korsholm L, Bendix T, Sorensen JS et al (2006) Modic changes and their associations with clinical findings. Eur Spine J 15:1312–1319

    Article  PubMed  Google Scholar 

  27. Kjaer P, Leboeuf-Yde C, Korsholm L, Sorensen JS et al. (2005) Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year-old men and women. Spine 30:1173–1180

    Article  PubMed  Google Scholar 

  28. Kjaer P, Leboeuf-Yde C, Sorensen JS, Bendix T (2005) An epidemiologic study of MRI and low back pain in 13-year-old children. Spine 30:798–806

    Article  PubMed  Google Scholar 

  29. Kovacs FM, Royuela A et al. (2009) Agreement in the interpretation of magnetic resonance images of the lumbar spine. Acta Radiologica 5:497–506

    Article  Google Scholar 

  30. Kuisma M, Karppinen J, Niinimaki J, Kurunlahti M et al. (2006) A three-year follow-up of lumbar spine endplate (Modic) changes. Spine 31:1714–1718

    Article  PubMed  Google Scholar 

  31. Kuisma M, Karppinen J, Niinimaki J, Ojala R et al. (2007) Modic changes in endplates of lumbar vertebral bodies: prevalence and association with low back and sciatic pain among middle-aged male workers. Spine 32:1116–1122

    Article  PubMed  Google Scholar 

  32. Kuisma M et al. (2009) Modic changes in vertebral endplate: a comparison of MR imaging and multislice CT. Skeletal Radiol 38:141–147

    Article  PubMed  Google Scholar 

  33. Lim CH, Jee WH, Son BC, Kim DH et al. (2005) Discogenic lumbar pain: association with MR imaging and CT discography. Eur J Radiol 54:431–437

    Article  PubMed  Google Scholar 

  34. Marchand F et al. (1990) Investigation of the laminate structure of lumbar disc anulus fibrosus. Spine 15:402–410

    Article  PubMed  CAS  Google Scholar 

  35. Masaryk TJ, Boumphrey F, Modic MT, Tamborrello C, Ross JS, Brown MD (1986) Effects of chemonucleolysis demonstrated by MR imaging. J Comput Assist Tomogr 10:917–923

    Article  PubMed  CAS  Google Scholar 

  36. McCall IW, Cessar-Pullicino VN, Tyrell PN. MR vertebral endplate changes and back pain. Abstract presented at the 25th Annual Meeting of the International Society for the Study of the Lumbar Spine; June, 2–6, 1998; Singapore

    Google Scholar 

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

    PubMed  CAS  Google Scholar 

  38. Modic MT, Ross JS (2007) Lumbar degenerative disk disease. Radiology 245:43–61

    Article  PubMed  Google Scholar 

  39. 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 166:193–199

    PubMed  CAS  Google Scholar 

  40. Morrison JL, Kaplan PA, Dussault RG, Anderson MW (2000) Pedicle marrow signal intensity changes in the lumbar spine: a manifestation of facet degenerative joint disease. Skeletal Radiol 29:703–707

    Article  PubMed  CAS  Google Scholar 

  41. Nachemson A (1966) The load on lumbar disks in different positions of the body. Clin Orthop 45:107–122

    PubMed  CAS  Google Scholar 

  42. Ohtori S, Inoue G, Ito T, Koshi T et al. (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 31:1026–1031

    Article  PubMed  Google Scholar 

  43. Pearce RH, Thompson JP, Berbault GM, Flak B (1991) Magnetic resonance imaging reflects the chemical changes of aging degeneration in human intervertebral disk. J Rheumatol Suppl 27:42–43

    PubMed  CAS  Google Scholar 

  44. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 26:1873–1878

    Article  PubMed  CAS  Google Scholar 

  45. Printzker KPH (1977) Aging and degeneration in the lumbar intervertebral disk. Orthop Clin North Am 8:65–77

    Google Scholar 

  46. Schenk P, Laubli T, Hodler J, Klipstein A (2006) Magnetic resonance imaging of the lumbar spine: findings in female subjects from administrative and nursing professions. Spine 31:2701–2706

    Article  PubMed  Google Scholar 

  47. Schmid G et al. (2004) Lumbar disk herniation: correlation of histologic findings with marrow signal intensity changes in vertebral endplates at MR imaging. Radiology 231:352–358

    Article  PubMed  Google Scholar 

  48. Takatalo J, Karppinen J et al. (2009) Prevalence of degenerative imaging findings in lumbar magnetic resonance imaging among young adults. Spine 34:1716–1721

    Article  PubMed  Google Scholar 

  49. Toyone T, Takahashi K, Kitahara H, Yamagata M, Murakami M, Moriya H (1994) Vertebral bone-marrow changes in degenerative lumbar disc disease: an MRI study of 74 patients with low back pain. J Bone Joint Surg Br 76:757–764

    PubMed  CAS  Google Scholar 

  50. Ulmer JL, Elster AD, Mathews VP, Allen AM (1995) Lumbar spondylolysis: reactive marrow changes seen in adjacent pedicles on MR images. Am J Roentgenol 164:429–433

    CAS  Google Scholar 

  51. Urban JP, Smith S, Fairbank JC (2004) Nutrition of the intervertebral disc. Spine 29:2700–2709

    Article  PubMed  Google Scholar 

  52. Van Goethem JW, Parizel PM, Jinkins JR (2002) Review article: MRI of the postoperative lumbar spine. Neuroradiology 44:723–739

    Article  PubMed  Google Scholar 

  53. Vital JM, Gille O, Pointillart V, Pedram M et al (2003) Course of Modic 1 six months after lumbar posterior osteosynthesis. Spine 28:715–720

    PubMed  CAS  Google Scholar 

  54. 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 209:661–666

    PubMed  CAS  Google Scholar 

  55. Weishaupt D, Zanetti M, Hodler J, Min K et al. (2001) Painful lumbar disk derangement: relevance of endplate abnormalities at MR imaging. Radiology 218:420–427

    PubMed  CAS  Google Scholar 

Download references

Conflict of interest statementWe declare that we have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to C. C. Quattrocchi .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag/Wien

About this chapter

Cite this chapter

Quattrocchi, C.C., Alexandre, A.M., Pepa, G.M.D., Altavilla, R., Zobel, B.B. (2011). Modic Changes: Anatomy, Pathophysiology and Clinical Correlation. In: Alexandre, A., Masini, M., Menchetti, P. (eds) Advances in Minimally Invasive Surgery and Therapy for Spine and Nerves. Acta Neurochirurgica Supplementum, vol 108. Springer, Vienna. https://doi.org/10.1007/978-3-211-99370-5_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-211-99370-5_9

  • Published:

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-99369-9

  • Online ISBN: 978-3-211-99370-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics