scholarly journals Associations between high intensity zones, Modic and endplate changes in lumbar spine of low back pain patients

2019 ◽  
Author(s):  
Kerstin Lagerstrand ◽  
Helena Brisby ◽  
Hanna Hebelka
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
High Intensity ◽  
T2 Mapping ◽  
Physiological Mechanism ◽  
Modic Changes ◽  
Morphological Features ◽  
Low Back ◽  
Endplate Changes ◽  
Tissue Characteristics

Abstract Background High intensity zones (HIZ), Modic and endplate changes have all been pointed out as potential markers of low back pain (LBP). If an association between these morphological features exist, it may not only deepen the understanding of the underlying patho-physiological mechanism of LBP but may also improve the diagnostics by enabling stratification between individuals with non-specific LBP as well as within individuals having multi-segmental changes. The aim was to investigate if HIZ, Modic and endplate changes are associated and if endplate and vertebral T2-values reflect functional tissue characteristics related to these morphological features.Methods 150 IVDs with corresponding endplates and vertebrae in 26 chronic LBP-patients (25-69y, mean 38y, 11 males) were examined with T1- and T2-weighted MRI, and T2-mapping. Associations between morphological features and between morphological features and functional T2-values were determined. Results HIZ (62% of patients, 1-2/patient) was associated with endplate changes (100% of patients, 1-7/patient) (p=0.0003 and 0.0004 for upper and lower endplates), with an occurrence of 91% for upper and 71% for lower endplates adjacent to discs with HIZ. Modic changes (81% of patients, 1-3/patient) was associated with endplate changes (p<0.0001) with an occurrence of 87% for endplates adjacent to vertebrae with Modic changes. The occurrence of both HIZ and Modic changes was 43% (p=0.0001) for upper and 29% (p=0.003) for lower vertebrae. Significantly higher T2-values (p<0.004) were found in the vertebral tissue with associated Modic changes and HIZ. Conclusions This study of LBP-patients suggests that HIZ is associated with simultaneous presence of both Modic and endplate changes in the same motion segment. If these three simultaneous morphological features are linked to an active inflammatory process, reflected as a clinical specific pain profile remains to be investigated.

scholarly journals Vertebral Endplate Changes / Modic Changes: An Audit Study Using Antibiotics in 147 Chronic Low Back Pain Patients

2016 ◽  
Vol 6 (1_suppl) ◽  
pp. s-0036-1582898-s-0036-1582898
Author(s):  
Claus Manniche ◽  
Lars Morsø ◽  
Lene Kiertzner
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Modic Changes ◽  
Low Back ◽  
Vertebral Endplate ◽  
Endplate Changes ◽  
Pain Patients

scholarly journals The effect of infliximab in patients with chronic low back pain and Modic changes (the BackToBasic study): study protocol of a randomized, double blind, placebo-controlled, multicenter trial

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Elisabeth Gjefsen ◽  
Lars Christian Haugli Bråten ◽  
Guro Løvik Goll ◽  
Monica Wigemyr ◽  
Nils Bolstad ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Treatment Strategy ◽  
Treatment Options ◽  
Modic Changes ◽  
Low Back ◽  
Double Blind ◽  
Link Type

Abstract Background Low back pain is common and a significant number of patients experience chronic low back pain. Current treatment options offer small to moderate effects. Patients with vertebral bone marrow lesions visualized as Modic changes on magnetic resonance imaging may represent a subgroup within the low back pain population. There is evidence for inflammatory mediators being involved in development of Modic changes; hence, suppression of inflammation could be a treatment strategy for these patients. This study examines the effect of anti-inflammatory treatment with the TNF-α inhibitor infliximab in patients with chronic low back pain and Modic changes. Methods/design The BackToBasic trial is a multicenter, double blind, randomized controlled trial conducted at six hospitals in Norway, comparing intravenous infusions with infliximab with placebo. One hundred twenty-six patients aged 18–65 with chronic low back pain and type 1 Modic changes will be recruited from secondary care outpatients’ clinics. The primary outcome is back pain-specific disability at day 154 (5 months). The study is designed to detect a difference in change of 10 (SD 18) in the Oswestry Disability Index at day 154/ 5 months. The study also aims to refine MRI-assessment, investigate safety and cost-effectiveness and explore the underlying biological mechanisms of Modic changes. Discussion Finding treatments that target underlying mechanisms could pose new treatment options for patients with low back pain. Suppression of inflammation could be a treatment strategy for patients with low back pain and Modic changes. This paper presents the design of the BackToBasic study, where we will assess the effect of an anti-inflammatory treatment versus placebo in patients with chronic low back pain and type 1 Modic changes. The study is registered at ClinicalTrials.gov under the identifier NCT03704363. The EudraCT Number: 2017–004861-29.

scholarly journals Clinical Significance of High-intensity Zone for Discogenic Low Back Pain: A Review

2016 ◽  
Vol 63 (1.2) ◽  
pp. 1-7 ◽  
Author(s):  
Subash C. Jha ◽  
Kosaku Higashino ◽  
Toshinori Sakai ◽  
Yoichiro Takata ◽  
Mitsunobu Abe ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Significance ◽  
High Intensity ◽  
Low Back ◽  
High Intensity Zone ◽  
Discogenic Low Back Pain

Association between types of Modic changes in the lumbar region and low back pain in a large cohort: the Wakayama spine study

2020 ◽  
Author(s):  
Yoshimasa Mera ◽  
Masatoshi Teraguchi ◽  
Hiroshi Hashizume ◽  
Hiroyuki Oka ◽  
Shigeyuki Muraki ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Modic Changes ◽  
Large Cohort ◽  
Lumbar Region ◽  
Low Back
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