Technical ReportModic changes: prevalence, distribution patterns, and association with age in white men
Introduction
Modic changes (MCs) are signal variations of the vertebral end plate and the adjacent subchondral vertebral marrow seen on magnetic resonance images (MRIs) [1], [2]. According to the patterns of signal changes on T1- and T2-weighted images, traditionally MCs have been classified into three types [1], [3]. Type 1 MCs show decreased signal intensity on T1-weighted images and increased signal intensity on T2-weighted images. Type 2 MCs demonstrate increased signal intensity on both T1- and T2-weighted images, whereas Type 3 MCs reflect decreased signal intensity on both T1- and T2-weighted images. The presence of different types of MCs together within an end plate was later regarded as mixed MCs, such as Mixed Type 1/2 and Mixed Type 2/3 [4], [5], [6].
Despite over 20 years of study, much about MCs remains either controversial or unknown. Assumed to be degenerative features of the vertebral end plate and marrow, MCs have long been suspected as a cause of low back pain [2], although this remains controversial [4], [7], [8], [9], [10]. Because of limited cases of biopsy, the pathologic nature of MCs largely remains unclear [2], [11]. Even the prevalence of MCs and the predominant type are uncertain. For example, the prevalence rates reported in the scientific literature widely range from 0.5% [12] to 62% [13]. Among the factors underlying the inconsistencies are variations in age and race of the subjects, back pain status [7], [14], and occupation [9]. To date, there are only two reports on MCs in the general population, which come from the same cohort [8], [15]. The role age may play in the pathogenesis of MCs, and the distribution pattern of MCs, has not yet been explored in the general population.
A systematic study of MCs in the lumbosacral region in the general population would provide fundamental epidemiologic insights of MCs and an important reference for clinical observations. The purpose of the present study was to investigate the prevalence and distribution pattern of MCs and their associations with age using a large population-based sample. Evidence suggests that MCs are closely related to disc [16], [17]. Thus, we refer to end plates containing MCs relative to the intervertebral disc and differentiate them as cranial and caudal to the adjacent disc.
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Subjects
This study used the lumbar MRI of the Twin Spine Study cohort [18], which consists of 300 pairs of male monozygotic and dizygotic twin pairs (N=600). Subjects were recruited from the population-based Finnish Twin Cohort, containing virtually all Finnish sex-matched twin pairs born before 1958 and alive in 1975, which has been shown to be representative of the general Finnish population [19]. Initially, monozygotic twins were recruited and compared with the larger twin cohort on a variety of
Prevalence of MCs
Of the 561 lumbar spines assessed, 55.6% (312 individuals; mean age, 51.4 years) had some sort of MCs present, and the remaining 44.4% (249 individuals; mean age, 47.7 years) had no MCs present. Observed in 29.2% (164) of subjects, Type 2 MCs were most common in our sample. Type 1 MCs were noted in only 6.4% (36) of subjects, whereas Type 1 and 2 MCs presented together (either at the same end plate or separate end plates of a spine) in another 18.0% (101) of lumbar spines. Type 3 MCs were
Discussion
Modic changes were found to be common MRI findings in the lumbar spines of a general population sample of middle-aged white men, with Type 2 MCs predominating. Mainly present in the lower lumbar region, MCs tended to affect both end plates adjacent to a disc simultaneously, and it commonly involved the entire AP diameter of the vertebral body. The presence and size of MCs were clearly related to age, suggesting that aging or associated factors may play an essential role in the pathogenesis of
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Author disclosures: YW: Nothing to disclose. TV: Nothing to disclose. MCB: Nothing to disclose.