Abstract
The purpose of this study was to analyze the association between the severity of inflammatory endplate changes (Modic) on MRI and the clinical response to intradiscal injection of corticosteroids (IDIC) in chronic low back pain (LBP). A total of 74 patients with LBP and inflammatory Modic changes who showed no response to 3-month conservative treatment received lumbar IDIC. Two spine specialists and a radiologist assessed independently the endplate marrow changes of the injected discs. We classified patients with a pure edema endplate changes on MRI as Modic type I (n = 37); those with a mixture of Modic type I and type II changes but predominantly edema changes as Modic I-2 (n = 25) and those with predominantly fatty changes as Modic II-1 (n = 12). The primary outcome was the change in LBP intensity between baseline and 1 month after IDIC, as measured on a visual analog scale (range 0–100 mm). At 1 month, reduction in pain score was significantly higher in the Modic I and Modic I-2 groups than in the Modic II-1 group (30.2 ± 26.6 and 29.4 ± 21.5 vs 5.3 ± 25.5; P = 0.009 and P = 0.017, respectively). At 3 and 6 months, IDIC tended to be more effective in the Modic I and Modic I-2 groups but not significantly. No complications such as infection or hematoma were reported. IDIC could be a short-term efficient treatment for patients with chronic LBP and predominantly inflammatory endplate changes when conservative treatments have failed.
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References
Andersson GBJ (1999) Epidemiological features of chronic low-back pain. Lancet 354:581–585
Atlas SJ, Nardin RA (2003) Evaluation and treatment of low back pain: an evidence-based approach to clinical care. Muscle Nerve 27:265–284
Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G (2006) Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2:CD005328
Braithwaite I, White J, Saifuddin A, Renton P, Taylor BA (1998) Vertebral end-plate (Modic) changes on lumbar spine MRI: correlation with pain reproduction at lumbar discography. Eur Spine J 7:363–368
Bram J, Zanetti M, Min K, Hodler J (1998) MR abnormalities of the intervertebral disks and adjacent bone marrow as predictors of segmental instability of the lumbar spine. Acta Radiol 39:18–23
Burke JG, Watson RW, McCormack D, Dowling FE, Walsh MG, Fitzpatrick JM (2002) Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. J Bone Joint Surg 84B:196–201
Buttermann GR (2004) The effect of spinal steroid injections for degenerative disc disease. Spine J 4:495–505
Chakravarty K, Pharoah PD, Scott DG (1994) A randomized controlled study of post-injection rest following intra-articular steroid therapy for knee synovitis. Br J Rheumatol 33:464–468
Chataigner H, Onimus M, Polette A (1998) Surgery for degenerative lumbar disc disease. Should the black disc be grafted? Rev Chir Orthop Reparatrice Appar Mot 84:583–589
Crock HV (1986) Internal disc disruption. A challenge to disc prolapse fifty years on. Spine 11:650–653
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
Deyo RA, Weinstein JN (2001) Low back pain. N Engl J Med 344:363–370
Ekman M, Jonhagen S, Hunsche E, Jonsson L (2005) Burden of illness of chronic low back pain in Sweden: a cross-sectional, retrospective study in primary care setting. Spine 30:1777–1785
Feffer HL (1969) Therapeutic intradiscal hydrocortisone. A long-term study. Clin Orthop Relat Res 67:100–104
Frymoyer JW, Cats Baril WL (1991) An overview of the incidences and cost of low back pain. Orthop Clin North Am 22:263–271
Goupille P, Jayson MI, Valat JP, Freemont AJ (1998) Matrix metalloproteinases: the clue to intervertebral disc degeneration? Spine 23:1612–1626
Graham CE (1975) Chemonucleolysis. A preliminary report on a double blind study comparing chemonucleolysis and intradiscal administration of hydrocortisone in the treatment of backache and sciatica. Orthop Clin North Am 6:259–263
Jinkins JR, Van Goethem JW (2001) The postsurgical lumbosacral spine. Magnetic resonance imaging evaluation following intervertebral disk surgery, surgical decompression, intervertebral bony fusion, and spinal instrumentation. Radiol Clin North Am 39:1–29
Khot A, Bowditch M, Powell J, Sharp D (2004) The use of intradiscal steroid therapy for lumbar spinal discogenic pain: a randomized controlled trial. Spine 29:833–836
Kjaer P, Leboeuf-Yde C, Korsholm L, Sorensen JS, Bendix T (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
Kopec JA, Esdaile JM, Abrahamowicz M, Abenhaim L, Wood-Dauphinee S, Lamping DL, Williams JI (1995) The quebec back pain disability scale. Measurement properties. Spine 20:341–352
Mitra D, Cassar-Pullicino VN, McCall IW (2004) Longitudinal study of vertebral type-1 end-plate changes on MR of the lumbar spine. Eur Radiol 14:1574–1581
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
Ohtori S, Inoue G, Ito T, Koshi T, Ozawa T, Doya H, Saito T, Moriya H, Takahashi K (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
Simmons JW, McMillin JN, Emery SF, Kimmich SJ (1992) Intradiscal steroids. A prospective double-blind clinical trial. Spine 17:S172–S175
Tehranzadeh J, Andrews C, Wong E (2000) Lumbar spine imaging. Normal variants, imaging pitfalls, and artifacts. Radiol Clin North Am 38:1207–1253
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 76B:757–764
Von Korff M, Saunders K (1996) The course of back pain in primary care. Spine 21:2833–2837
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
Weishaupt D, Zanetti M, Hodler J, Min K, Fuchs B, Pfirrmann C, Boos N (2001) Painful lumbar disk derangement: relevance of endplate abnormalities at MR Imaging. Radiology 218:420–427
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Fayad, F., Lefevre-Colau, MM., Rannou, F. et al. Relation of inflammatory modic changes to intradiscal steroid injection outcome in chronic low back pain. Eur Spine J 16, 925–931 (2007). https://doi.org/10.1007/s00586-006-0301-y
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DOI: https://doi.org/10.1007/s00586-006-0301-y