Modic changes

Modic changes are pathological changes in the bones of the spine, the vertebrae. These changes are situated in both the body of the vertebrae and in the end plate of the neighboring disc.

Causes of back pain

Only in 20 % of the patients can we identify an anatomical reason for the pain, such as a lumbar disc herniation, or stenosis which is a reduction in the circumference of the spinal canal.

There might be reasons for back pain that cannot be identified on magnetic resonance imaging (MRI), for example muscular pain. But other areas like knee or hip pain do a lot better when it comes to diagnosing the exact reasons for the pain. The low percentage for back diagnosis might be due to the fact that the back is a much more complex and complicated structure.

Diagnosing modic changes

Modic changes can only be seen on a magnetic resonance imaging, an MRI. Modic changes were first described and separated into 3 different types of changes by Dr. Michael Modic in 1988.

Normal bone consists of an internal scaffolding of bone, called trabeculae. In the hollows between the trabeculae is red bone marrow, which produces blood cells.

• In Modic type 1 the trabeculae are fractured in many places, the trabeculae are shorter and broader and the “scaffolding” pattern is unstructured and uneven. The marrow is substituted by serum, the same clear liquid that is inside a blister.

• In Modic type 2 changes the trabeculae are also fractured in many places, but are shorter and broader and the "scaffolding" pattern is unstructured and uneven. With Modic type 2 changes the marrow is substituted by visceral fat, the same kind of fat we have on our hips and bellies.

• Modic Changes type 3 are rare, and it is bone scar tissue.

Modic changes and pain

Many studies^[which?] have examined the relationship between Modic changes in the vertebrae in the spine and pain in the lower back. There is a very strong correlation between having Modic changes, especially Modic changes type 1, and suffering from pain in the lower back.

Studies^[which?] have shown that patients with Modic changes are rather different from other patients with normal back pain. For example 75 –80 % of patients suffering from Modic changes have constant pain, which means they do not ever have a pain-free moment day or night. There might be fluctuations in the intensity, but no break from the pain. 75% of the patients also suffers from pain during the night, and many wake up during the night because it is painful to turn in bed.

Treatment

It is difficult to treat patients with Modic changes. Treatment that normally cures or help patients with normal back pain does not have effect on Modic changes or pain from Modic changes.

The recommended treatment for long lasting pain in the lower back is exercises, normally aided by the instruction of a qualified physiotherapist. This is often followed by muscle strengthening and fitness training. This treatment does help the vast majority of normal back pain patients. But studies^[which?] have shown that patients with Modic changes showed much higher pain score than patients with normal back pain, and most importantly that their pain increased with training.

Research

Scientist at the largest back center in Europe, the Back Centre of the Region of Southern Denmark, performed studies that have shovn that 80% of patients with Modic changes type 1 are cured or much improved after a cheap and simple treatment.

Bibliography

• Modic MT, Steinberg PM, Ross JS, et al. : "Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging". I Radiology 1988;166(1 Pt 1):193-9.
• Modic MT, Masaryk TJ, Ross JS, Carter JR. : "Imaging af degererative disk disease". I Radiology 1988;168:177-86.
• Albert HB, Kjaer P, Jensen TS, Sorensen JS, Bendix T, Manniche C : "Modic changes, possible causes and relation to low back pain.". I Med Hypotheses. 2008;70(2):361-8. Epub 2007 Jul 10
• Albert HB, Manniche C. : "Modic changes following lumbar disc herniation.". I Eur Spine J. 2007 Jul;16(7):977-82. Epub 2007 Mar 3.