What causes new vertebral endplate signal changes (modic changes)?

Transcription

1 What causes new vertebral endplate signal changes (modic changes)? Poster No.: C-2417 Congress: ECR 2010 Type: Scientific Exhibit Topic: Musculoskeletal Authors: T. S. Jensen 1, P. Kjaer 2, L. Korsholm 2, T. Bendix 2, J. S. Keywords: DOI: Sorensen 1, C. Manniche 1, C. Leboeuf-Yde 1 ; 1 Ringe/DK, 2 Odense/ DK Modic changes, Disc degeneration, Disc herniation /ecr2010/C-2417 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 11

2 Purpose A recent article has reported that the prevalence of Modic changes (Figure 1 and 2) increases from the age of 40 to the age of 44 years.[5] This increase is expected as Modic changes have been proposed to be linked to deterioration of the intervertebral disc, especially disc herniations. [1,2,7]. However, very little is still known about the aetiology of this condition. The purpose of this study was to investigate the possible predictive value of lifestyle factors and disc-related MRI findings in relation to the development of new vertebral endplate signal changes (Modic changes). Images for this section: Fig. 1 Page 2 of 11

3 Fig. 2 Page 3 of 11

4 Methods and Materials In this prospective observational study, 344 people (161 men and 183 women) from a Danish general population were included. All participants had an MRI and completed LBP questionnaires at the age of 40 and again at 44 years. Modic changes were evaluated according to the Nordic Modic Consensus Group classification (Figure 1).[6] The following potential predictors of new Modic changes were chosen for the analysis: Gender Disc-related MRI findings: Disc degeneration (hypointense disc signal[3,12] or reduced disc height (grades 2 or 3)[9,10,12]) Disc bulge[4]) Disc herniation (Protrusions, extrusions, and sequestrations[4]) Other endplate changes (Irregular endplates, Schmorl's nodes, and/or local defects[11]) Lifestyle factors High physical work activity (Heavy physical work, heavy lifting either now or previously[8]) High physical leisure activity (Active in sports/hard physical load in leisure time activity at least 3 hrs/week or participating in competitive sports[8]) High Body Mass Index (BMI>25) Heavy smoking (More than 20 cigarettes a day) Bivariable and multivariable logistic regression analyses were used to identify predictors of new Modic changes. Images for this section: Page 4 of 11

5 Fig. 1: Classification of the size of VESC related to its relative depth of extension of the vertebral body height: A: Endplate (EP) only, B: < 25%, C: 25-50%, and D: >50%.[19] Page 5 of 11

6 Results New Modic changes at the age of 44 appeared in 67 (19%) of the 344 persons included in the study (Figure 1). The majority (84%) of these new signal changes were Modic type 1 changes and almost half (45%) were observed only in the endplate and did not extend further into the vertebral body. In the multivariable analysis, lumbar disc levels with disc degeneration, bulge or herniation at 40 were the only predictors of new Modic changes at the age of 44 (Figure 2). Images for this section: Page 6 of 11

7 Page 7 of 11

8 Fig. 1: The proportion of persons with VESC at age 40 (A) and age 44 (B) in 344 persons from the Danish general population. (C) represents the persons VESC status at age 44 in relation to their VESC status at age 40.[5] Fig. 2: Odds ratios (95% CI) of statistically significant predictors of new Modic changes in 344 people from the general Danish population. Page 8 of 11

9 Conclusion The development of new Modic changes in the general population appears to be based on the status and dynamics of the intervertebral disc, rather than the result of gender or lifestyle factors such as smoking, high BMI and/or physical load. Note: An article based on the results presented in this poster has recently been published in European Spine Journal p=36f c24d52aef94fe1c1d4412c&pi=17 References 1. Albert HB, Manniche C: Modic changes following lumbar disc herniation. Eur Spine J 2007, 16: Barth M, Diepers M, Weiss C, Thome C: Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 2: radiographic evaluation and correlation with clinical outcome. Spine 2008, 33: Eyre D, Nemya P, Buckwalter, Caterson.N, Heinegard D, Oegema T et al.: Intervertebral Disk: Basic Science perspectives. In New Perspectives on Low Back Pain. Edited by Frymoyer JW, Gordon SL. American Academy of Orthopaedic Surgeons; 1989: Fardon DF, Milette PC: 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 2001, 26: E93-E Jensen TS, Bendix T, Sorensen JS, Manniche C, Korsholm L, Kjaer P: Characteristics and natural course of vertebral endplate signal (Modic) changes in the Danish general population. BMC Musculoskelet Disord 2009, 10: Jensen TS, Sorensen JS, Kjaer P: Intra- and interobserver reproducibility of vertebral endplate signal (modic) changes in the lumbar spine: the Nordic Modic Consensus Group classification. Acta Radiol 2007, 48: Kuisma M, Karppinen J, Niinimaki J, Kurunlahti M, Haapea M, Vanharanta H et al.: A three-year follow-up of lumbar spine endplate (Modic) changes. Spine 2006, 31: Page 9 of 11

10 8. Kuorinka I, Jonsson B, Kilbom A, Biering-Sorensen F, Andersson G, Jørgensen K: Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Applied Ergonomics 1987, 18: Raininko R, Manninen H, Battie MC, Gibbons LE, Gill K, Fisher LD: Observer variability in the assessment of disc degeneration on magnetic resonance images of the lumbar and thoracic spine. Spine 1995, 20: Roberts N, Gratin C, Whitehouse GH: MRI analysis of lumbar intervertebral disc height in young and older populations. J Magn Reson Imaging 1997, 7: Videman T, Battie MC, Gill K, Manninen H, Gibbons LE, Fisher LD: Magnetic resonance imaging findings and their relationships in the thoracic and lumbar spine. Insights into the etiopathogenesis of spinal degeneration. Spine 1995, 20: Weishaupt D, Zanetti M, Hodler J, Boos N: 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 1998, 209: Personal Information Tue S. Jensen, MHSc (Clin Biomech), PhD 1,2, Per Kjaer, PT, PhD 1, Lars Korsholm, PhD 3, Tom Bendix, Dr.Med.Sci 2, Joan S. Sorensen, MD 1, Claus Manniche, Dr.Med.Sci 1, Charlotte Leboeuf-Yde, DC, MPH, PhD 1 Affiliations 1 The Back Research Centre, Ringe, Denmark. 2 Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. 3 Department of Statistics, University of Southern Denmark, Odense, Denmark Corresponding author Tue Secher Jensen, MHSc (Clin Biomech), PhD The Spine Centre of Sourthern Denmark Page 10 of 11

11 Lindevej 5 DK-5750 Ringe Phone: Mobile: Tue.Secher.Jensen@slb.regionsyddanmark.dk Page 11 of 11