Title: A definition and clinical grading of Modic changes

OBJECTIVEThe aim of this study was to evaluate the effect of lumbar sacralization on the level of vertebral slip and disc degeneration in patients with L4 spondylolysis.METHODSThe authors analyzed data from 102 cases in which patients underwent surgical treatment for L4 spondylolysis and spondylolisthesis at their institution between March 2007 and September 2016. Lumbar sacralization was characterized by the presence of pseudarthrosis and/or bony fusion between the L5 transverse process and sacrum, and the type of lumbosacral transitional vertebra (LSTV) was evaluated with the Castellvi classification. The amount of vertebral slippage was measured using the Taillard technique and Meyerding grade. Degeneration of the L4–5 segment was quantified using the Pfirrmann and Modic classifications. Patients were divided into 2 groups based on the presence or absence of sacralization, and the amount of vertebral slip and degeneration of the L4–5 segment was compared between groups.RESULTSLumbar sacralization was present in 37 (36%) of 102 patients with L4 spondylolysis. The LSTV was type IIa in 10 cases, type IIb in 7, type IIIa in 2, and type IIIb in 18. The levels of vertebral slip and disc degeneration in the group of patients with sacralization were significantly greater than in the group without sacralization. No significant difference was found between the 2 groups with respect to Modic changes.CONCLUSIONSThe increased stability between a sacralized L5 and the sacrum may predispose the L4–5 segment to greater instability and disc degeneration in patients with L4 spondylolysis.

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A grading scale for surgically treated patients with spontaneous supratentorial intracerebral hemorrhage: the Surgical Swedish ICH Score

Journal of Neurosurgery ◽

10.3171/2019.5.jns19622 ◽

2020 ◽

Vol 133 (3) ◽

pp. 800-807 ◽

Cited By ~ 3

Author(s):

Andreas Fahlström ◽

Henrietta Nittby Redebrandt ◽

Hugo Zeberg ◽

Jiri Bartek ◽

Andreas Bartley ◽

...

Keyword(s):

Type 2 Diabetes ◽

Intracerebral Hemorrhage ◽

External Validation ◽

Grading Scale ◽

Ich Score ◽

Gcs Score ◽

Strength Of Association ◽

Point Type ◽

Clinical Grading

OBJECTIVEThe authors aimed to develop the first clinical grading scale for patients with surgically treated spontaneous supratentorial intracerebral hemorrhage (ICH).METHODSA nationwide multicenter study including 401 ICH patients surgically treated by craniotomy and evacuation of a spontaneous supratentorial ICH was conducted between January 1, 2011, and December 31, 2015. All neurosurgical centers in Sweden were included. All medical records and neuroimaging studies were retrospectively reviewed. Independent predictors of 30-day mortality were identified by logistic regression. A risk stratification scale (the Surgical Swedish ICH [SwICH] Score) was developed using weighting of independent predictors based on strength of association.RESULTSFactors independently associated with 30-day mortality were Glasgow Coma Scale (GCS) score (p = 0.00015), ICH volume ≥ 50 mL (p = 0.031), patient age ≥ 75 years (p = 0.0056), prior myocardial infarction (MI) (p = 0.00081), and type 2 diabetes (p = 0.0093). The Surgical SwICH Score was the sum of individual points assigned as follows: GCS score 15–13 (0 points), 12–5 (1 point), 4–3 (2 points); age ≥ 75 years (1 point); ICH volume ≥ 50 mL (1 point); type 2 diabetes (1 point); prior MI (1 point). Each increase in the Surgical SwICH Score was associated with a progressively increased 30-day mortality (p = 0.0002). No patient with a Surgical SwICH Score of 0 died, whereas the 30-day mortality rates for patients with Surgical SwICH Scores of 1, 2, 3, and 4 were 5%, 12%, 31%, and 58%, respectively.CONCLUSIONSThe Surgical SwICH Score is a predictor of 30-day mortality in patients treated surgically for spontaneous supratentorial ICH. External validation is needed to assess the predictive value as well as the generalizability of the Surgical SwICH Score.

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Faculty Opinions recommendation of Clinical grading scales in intracerebral hemorrhage.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.4786957.4691055 ◽

2010 ◽

Author(s):

Giuseppe Citerio ◽

M Giulia Abate

Keyword(s):

Intracerebral Hemorrhage ◽

Grading Scales ◽

Clinical Grading

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Lumbar Disc Herniation and Preoperative Modic Changes: A Prospective Analysis of the Clinical Outcomes After Microdiscectomy

Global Spine Journal ◽

10.1177/2192568220976089 ◽

2021 ◽

pp. 219256822097608

Author(s):

Dinesh Kumarasamy ◽

Shanmuganathan Rajasekaran ◽

Sri Vijay Anand K. S ◽

Dilip Chand Raja Soundararajan ◽

Ajoy Prasad Shetty T ◽

...

Keyword(s):

Patient Satisfaction ◽

Back Pain ◽

Clinical Outcomes ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Rating Scale ◽

Lumbar Disc ◽

Modic Changes ◽

P Value ◽

Functional Scores

Study design: Prospective comparative cohort study. Objectives: The study aims to elucidate the relationship between Modic endplate changes and clinical outcomes after a lumbar microdiscectomy. Methods: Consecutive patients undergoing microdiscectomy for lumbar disc herniation (LDH) were prospectively studied. Pre-operative clinical and radiological parameters were recorded. The pain was assessed by Numeric pain rating scale (NPRS), and functional assessment by Oswestry Disability Index (ODI). Minimal clinically important difference (MCID) in outcome was calculated for both the groups. Complications related to surgery were studied. Follow-up was done at 6 weeks, 3 months, 6 months and 1 year. Mac Nab criteria were used to assess patient satisfaction at 1 year. Results: Out of 309 patients, 86 had Modic changes, and 223 had no Modic changes. Both groups had similar back pain (p-value: 0.07) and functional scores (p-value: 0.85) pre-operatively. Postoperatively patients with Modic changes had poorer back pain and ODI scores in the third month, sixth month and 1 year (p-value: 0.001). However, MCID between the groups were not significant (p-value: 0.18 for back pain and 0.58 for ODI scores). Mac Nab criteria at 1 year were worse in Modic patients (p-value: 0.001). No difference was noted among Modic types in the pre-operative and postoperative pain and functional outcomes. Four patients in Modic group (4.7%) and one patient in the non-Modic group (0.5%) developed postoperative discitis (p-value: 0.009). Conclusions: Preoperative Modic changes in lumbar disc herniation is associated with less favorable back pain, functional scores and patient satisfaction in patients undergoing microdiscectomy.

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What is the Role of the Bacterium Propionibacterium acnes in Type 1 Modic Changes? A Review of the Literature

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2017.07.004 ◽

2017 ◽

Vol 68 (4) ◽

pp. 419-424 ◽

Cited By ~ 10

Author(s):

Mark Georgy ◽

Mark Stern ◽

Kieran Murphy

Keyword(s):

Randomized Controlled Trial ◽

Propionibacterium Acnes ◽

Controlled Trial ◽

Modic Changes ◽

Low Back ◽

Review Of The Literature ◽

Disc Disease ◽

Randomized Controlled

This review presents a summary of the pathology and epidemiology of Modic changes and the possible role of Propionibacterium acnes. This information is followed by a synthesis of the most recent clinical research involved in culturing the discs of patients with degenerative disc disease for the presence of bacteria. We also discuss a randomized controlled trial that investigates the effects of antibiotics on patients with chronic low back pain and type 1 Modic changes. We conclude with a brief discussion of the difficulties involved in this research and the significance of the findings.

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Is the development of Modic changes associated with clinical symptoms? A 14-month cohort study with MRI

European Spine Journal ◽

10.1007/s00586-012-2309-9 ◽

2012 ◽

Vol 21 (11) ◽

pp. 2271-2279 ◽

Cited By ~ 46

Author(s):

Rikke K. Jensen ◽

Charlotte Leboeuf-Yde ◽

Niels Wedderkopp ◽

Joan S. Sorensen ◽

Tue S. Jensen ◽

...

Keyword(s):

Cohort Study ◽

Clinical Symptoms ◽

Modic Changes

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Is the Distribution Pattern of Modic Changes in Vertebral End-plates Associated With the Severity of Intervertebral Disc Degeneration?: A Cross-sectional Analysis of 527 Caucasians

World Neurosurgery ◽

10.1016/j.wneu.2021.02.128 ◽

2021 ◽

Author(s):

Emel Ece Özcan-Ekşi ◽

Ali Yayla ◽

Ömer Orhun ◽

Veli Umut Turgut ◽

Havva Nur Arslan ◽

...

Keyword(s):

Intervertebral Disc ◽

Distribution Pattern ◽

Disc Degeneration ◽

Intervertebral Disc Degeneration ◽

Modic Changes ◽

Cross Sectional ◽

Cross Sectional Analysis ◽

Sectional Analysis

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Development and Evaluation of a Summative Clinical Grading Tool

Journal of Nursing Education ◽

10.3928/0148-4834-19860501-12 ◽

1986 ◽

Vol 25 (5) ◽

pp. 218-220

Author(s):

Kathleen B Hillegas ◽

Susan Valentine

Keyword(s):

Clinical Grading

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Non-mydriatic ultrawide field scanning laser ophthalmoscopy compared with dilated fundal examination for assessment of diabetic retinopathy and diabetic macular oedema in Chinese individuals with diabetes mellitus

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-311924 ◽

2018 ◽

Vol 103 (9) ◽

pp. 1327-1331 ◽

Cited By ~ 1

Author(s):

Simon K H Szeto ◽

Raymond Wong ◽

Jerry Lok ◽

Fangyao Tang ◽

Zihan Sun ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Clinical Examination ◽

Macular Oedema ◽

Chinese Population ◽

Retrospective Cohort ◽

Diabetic Macular Oedema ◽

Scanning Laser ◽

Scanning Laser Ophthalmoscopy ◽

Chinese Cohort ◽

Clinical Grading

AimsTo evaluate the performance of ultrawide field scanning laser ophthalmoscopy (UWF-SLO) for assessing diabetic retinopathy (DR) and diabetic macular oedema (DME) in a Chinese population, compared with clinical examination.MethodsThis is a retrospective cohort study. A series of 322 eyes from 164 patients with DM were included. Each patient underwent both dilated fundal examination with DR and DME grading by retina specialist and non-mydriatic 200° UWF-SLO (Daytona, Optos, Dunfermline, UK). The severity of DR and DME from UWF-SLO images was further graded by ophthalmologists, according to both international clinical DR and DME disease severity scales and the standard 7-field Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Any DR, DME and vision-threatening DR (VTDR) were treated as endpoints for this study.Results23 out of 322 images (7.14%), including all four cases with proliferative DR on clinical examinations, were determined as ungradable. When the international scale was used for grading UWF-SLO images, the sensitivity of any DR, DME and VTDR was 67.7%, 67.4% and 72.6%, respectively; the specificity of any DR, DME and VTDR was 97.8%, 97.3% and 97.8%, respectively. The agreement with clinical grading in picking up any DR, DME and VTDR was substantial, with κ-values of 0.634, 0.694 and 0.707, respectively. The performance of UWF-SLO was shown to be lower when ETDRS scale was used for grading the images.ConclusionThe performance of non-mydriatic UWF-SLO is comparable in identifying DR with that of clinical examination in a Chinese cohort. However, whether UWF-SLO can be considered as tool for screening DR is still undetermined.

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