scholarly journals Intervertebral disc vacuum phenomenon is associated with Modic changes in the adjacent endplate: implications for discogenic back pain

2020 ◽  
Author(s):  
Junhui Liu ◽  
Yufeng Xiang ◽  
Zhi Shan ◽  
Shunwu Fan ◽  
Fengdong Zhao
Keyword(s):  
Back Pain ◽  
Lumbar Disc ◽  
Intervertebral Discs ◽  
Modic Changes ◽  
Type I ◽  
Type Ii ◽  
Vacuum Phenomenon ◽  
Lower Lumbar Spine ◽  
Lumbar Degenerative Diseases ◽  
Lower Lumbar

Abstract Background Back pain often arises from degenerative changes in lumbar intervertebral discs and their adjacent endplates. A painful endplate is not easy to identify in patients, but could possibly be revealed by inflammatory-like ‘Modic’ changes and by a ‘vacuum phenomenon’ within the disc. We hypothesize that Modic changes and a VP often co-exist in those lumbar levels most closely associated with back pain Methods We scanned 1023 consecutive inpatients of the Department of Orthopaedics from 2015 August to 2018 August, all patients suffered from lumbar degenerative diseases, whether the patients had back pain or not were evaluated, and the prevalence and location of vacuum phenomenon(VP) and Modic changes were compared at each spinal level. Results 5115 discs were studied from 1023 patients. The number of discs showed to have a VP was 430 using CT, of the 430 discs with a CT-diagnosed VP, 116 were L4-5, and 171 were L5-S1. 522 of the 5115 discs exhibited Modic changes, with prevalence of type I, type II and type III Modic changes being 1.6%, 8.2% and 0.4% respectively. Modic changes usually occurred adjacent to L4-5 discs or L5-S1 discs. The prevalence of back pain was higher in the VP group than no-VP group, VP were significantly associated with Modic changes Type II at L4/5 and at L5/S1. Conclusion VP are closely associated with back pain and Modic changes in the lower lumbar spine. Further investigations may be warranted when radiographs or CT identify a VP in a lumbar disc.

scholarly journals Intervertebral disc vacuum phenomenon is associated with Modic changes in the adjacent endplate: implications for discogenic back pain

2020 ◽  
Author(s):  
Junhui Liu ◽  
Yufeng Xiang ◽  
Zhi Shan ◽  
Shunwu Fan ◽  
Fengdong Zhao
Keyword(s):  
Back Pain ◽  
Lumbar Disc ◽  
Intervertebral Discs ◽  
Modic Changes ◽  
Type I ◽  
Type Ii ◽  
Vacuum Phenomenon ◽  
Lower Lumbar Spine ◽  
Lumbar Degenerative Diseases ◽  
Lower Lumbar

Abstract Background: Back pain often arises from degenerative changes in lumbar intervertebral discs and their adjacent endplates. A painful endplate is not easy to identify in patients, but it could be possibly revealed by inflammatory-like ‘Modic’ changes and by a ‘vacuum phenomenon’ within the disc. We hypothesize that Modic changes and a VP often co-exist in those lumbar levels most closely associated with back pain. Methods: We scanned 1023 consecutive inpatients of the Department of Orthopaedics from 2015 August to 2018 August, all patients suffered from lumbar degenerative diseases. Whether the patients had back pain or not were evaluated, and the prevalence and location of vacuum phenomenon(VP) and Modic changes were compared at each spinal level. Results: 5115 discs were studied from 1023 patients. The number of discs showed to have a VP was 430 using CT. Of the 430 discs with a CT-diagnosed VP, 116 were L4-5, and 171 were L5-S1. 522 of the 5115 discs exhibited Modic changes, with the prevalence of type I, type II and type III Modic changes being 1.6%, 8.2% and 0.4% respectively. Modic changes usually occurred adjacent to L4-5 discs or L5-S1 discs. The prevalence of back pain was higher in the VP group than no-VP group, VP were significantly associated with Modic changes Type II at L4/5 and at L5/S1.Conclusion: VP are closely associated with back pain and Modic changes in the lower lumbar spine. Further investigations may be warranted when radiographs or CT identify a VP in a lumbar disc.

scholarly journals Analyzing the Influence of Modic Changes on Patients with Lower Back Pain Undergoing Conservative Treatment

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Yufeng Chen ◽  
Huilin Yang ◽  
Lianfang Zhang ◽  
Yue Wang ◽  
Jun Zou
Keyword(s):  
Back Pain ◽  
Lower Back Pain ◽  
Modic Changes ◽  
Nonsurgical Treatment ◽  
Type I ◽  
Type Ii ◽  
Lower Back ◽  
Significant Difference ◽  
Modic Type ◽  
Vas Scores

Objective. This study aimed to investigate if the presence of Modic changes (MCs) was correlated with lower back pain (LBP) and LBP-related disability in patients who underwent nonsurgical treatment. Methods. In this study, 129 patients who experienced consecutive LBP and underwent lumbar spine magnetic resonance imaging in our institute were divided into three groups according to the presence or type of MCs. The Oswestry Disability Index (ODI) and visual analog scale (VAS) were used to assess the outcomes of the treatment. Results. Based on the achieved results, there was no significant difference between three groups before treatment (P>0.05). Three months after undergoing nonsurgical treatment, the rates of improved ODI and VAS scores were statistically significantly different (P=0.014,  0.023). After an additional 3 months of treatment, in patients with Modic type I changes, the symptoms significantly improved in comparison with those 3 months prior (P=0.037,  0.026), while that improvement did not occur in patients with Modic type II changes (P>0.05). Conclusions. The existence of MCs affects the outcomes of nonsurgical treatment in patients with LBP. However, symptoms can be improved after an additional round of treatment for Modic type I changes, while this is not confirmed for Modic type II changes.

scholarly journals Correlation between Sagittal Morphology of Lower Lumbar Endplate and Degenerative Changes in Patients with Lumbar Disc Herniation

2020 ◽  
Author(s):  
Chongqing Xu ◽  
Mengchen Yin ◽  
Wen Mo
Keyword(s):  
Disc Degeneration ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Intervertebral Discs ◽  
Modic Changes ◽  
Observer Agreement ◽  
Imaging Data ◽  
Lumbar Disc Degeneration ◽  
Lower Lumbar

Abstract Background: As an important anatomic factor in the process of Lumbar disc herniation (LDH), the correlation between endplate sagittal morphology and intervertebral disc degeneration (IDD) is unclear. and research on imaging data of lumbar endplate in patients with LDH is still insufficient. Our study aimed to observe the morphological change of the lower lumbar endplate (L3-S1) in patients with LDH on magnetic resonance imaging (MRI), and analyze its correlation with the degree of IDD.Methods/Design: All 116 patients were included. Based on their MRI, we divided endplates into three types (concave, flat and irregular), assigned intervertebral discs with Grade I-V given 1-5 points successively according to Pfirrmann system, and determined whether there was Modic change of each endplate. The correlation between the morphology of endplate and the degree of IDD was analyzed.Results: There were excellent inter-observer agreement for each item we analyzed (ICC > 0.75). Concave endplate appeared most frequently (187, 53.7%) and mainly distributed in L3/4 and L4/5, while irregular endplate was the least common type (54, 15.5%) and mainly concentrated in L5/S1. The IDD degree of corresponding disc increased gradually from concave (3.27 ± 0.81) to irregular endplates (4.25 ± 0.79) (P < 0.05). Irregular endplates were more likely to have Modic changes than concave and flat endplates (P < 0.05). Conclusion: The sagittal morphology of lower lumbar endplate is related to Modic changes and degree of IDD (based on Pfirrmann grading system) in patients with LDH, and the concave endplate mostly reflects a lower degree of lumbar disc degeneration, which has substantial clinical significance.

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

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.

scholarly journals Analysis of the efficacy of ozone therapy on different types of lumbar disc herniation: a new guidance is coming? [abstract]

2019 ◽  
Vol 3 (4) ◽  
Author(s):  
Kenan Hao ◽  
Huan Liu ◽  
Yang Yang ◽  
Qingle Zeng ◽  
Xiaofeng He
Keyword(s):  
Nucleus Pulposus ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Ozone Treatment ◽  
Type I ◽  
Type Ii ◽  
Ring Type ◽  
Type Iv ◽  
Fibre Ring

PURPOSE: To investigate the sub-types of lumbar disc herniation, compare efficacies of ozone treatment in various types of lumbar disc herniation and analyze the mechanisms. MATERIAL AND METHODS: A total of 250 patients (159 males, 91 females; age range: 14 - 85 years) diagnosed of lumbar disc herniation from January 2009 to Jun 2014 in Nanfang Hospital were enrolled. Disc Lesions, classified by Magnetic Resonance examinations and images when injecting ozone under Digital Subtraction Angiography, were divided into four types: type I: Non-prominent nucleus pulposus with ruptured fibre ring; type II: Prominent nucleus pulposus with ruptured fibre ring; type III: Non-prominent nucleus pulposus with Non-ruptured fibre ring; type IV: Prominent nucleus pulposus with Non-ruptured fibre ring. All patients underwent intradiscal and paravertebral injection of oxygen-ozone. Visual Analogue Scale (VAS) weighted score was administered for the measurement of low back pain before treatment, and the evaluation of efficacy respectively at 1 week, 1 month, 6 month and 12 month follow-up period. RESULTS: Most of the patients (about 4/5) showed better response to ozone treatment. Herniated disc shrinkage was obtained among type II and IV. The type II had the most reduction of average score while the type III had the least. The proportion of patients who had once experienced pain relief at the follow up interval, namely the curative efficacy, showed significant difference: type I occupied the most, type IV occupied the least. CONCLUSION: Ozone treatment is effective and safe for all types of lumbar disc herniation, but efficacy varies according the types, of which type I has the best results and type IV has the worst ones.

Association of Modic changes with health-related quality of life among patients referred to spine surgery

2014 ◽  
Vol 5 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Juhani Määttä ◽  
Hannu Kautiainen ◽  
Ville Leinonen ◽  
Jaakko Niinimäki ◽  
Salme Järvenpää ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spine Surgery ◽  
Modic Changes ◽  
Type I ◽  
Type Ii ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
The Relationship

AbstractBackground and purposeModic changes (MC) are bone marrow and vertebral endplate lesions seen in magnetic resonance imaging (MRI) which have been found to be associated with low back pain (LBP), but the association between MC and health-related quality of life (HRQoL) is poorly understood. The aim of this study was to assess the relationship between MC and HRQoL among patients referred to spine surgery.MethodsThe study population consisted of 181 patients referred to lumbar spine surgery in Northern and Eastern Finland between June 2007 and January 2011. HRQoL was assessed using RAND-36 health survey. Lumbar MC were evaluated and classified into ‘No MC’, ‘Type I’ (Type I or I/II), and ‘Type II’ (Type II, II/III or III).ResultsIn total, 84 patients (46%) had MC. Of these, 37% had ‘Type I’ and 63% ‘Type II’. Patients with MC were older, more likely females, had longer duration of LBP and a higher degree of disc degeneration than patients without MC. The total physical component or physical dimensions did not differ significantly between the groups. The total mental component of RAND-36 (P = 0.010), and dimensions of energy (P = 0.023), emotional well-being (P = 0.012) and emotional role functioning (P = 0.016) differed significantly between the groups after adjustments for age and gender. In the mental dimension scores, a statistically significant difference was found between ‘No MC’ and ‘Type II’.ConclusionsAmong patients referred to spine surgery, MC were not associated with physical dimensions of HRQoL including dimension of pain. However, ‘Type II’ MC were associated with lower mental status of HRQoL.ImplicationsOur study would suggest that Type II MC were associated with a worse mental status. This may affect the outcome of surgery as it is well recognized that patients with depression, for instance, have smaller improvements in HRQoL and disability. Thus the value of operative treatment for these patients should be recognized and taken into consideration in treatment. Our study shows that MC may affect outcome and thus clinicians and researchers should be cognizant of this and take this into account when comparing outcomes of surgical treatment in the future. A longitudinal study would be needed to properly address the relationship of MC with surgical outcome.

scholarly journals Spinal Kinematics of Adolescent Male Rowers with Back Pain in Comparison with Matched Controls During Ergometer Rowing

2015 ◽  
Vol 31 (6) ◽  
pp. 459-468 ◽  
Author(s):  
Leo Ng ◽  
Amity Campbell ◽  
Angus Burnett ◽  
Anne Smith ◽  
Peter O’Sullivan
Keyword(s):  
Back Pain ◽  
Lumbar Spine ◽  
Tracking System ◽  
Adolescent Male ◽  
Lower Lumbar Spine ◽  
Spinal Kinematics ◽  
Ergometer Rowing ◽  
History Of ◽  
Lumbar Spinal ◽  
Lower Lumbar

There is a high prevalence of low back pain (LBP) in adolescent male rowers. In this study, regional lumbar spinal kinematics and self-reported LBP intensity were compared between 10 adolescent rowers with moderate levels of LBP relating to rowing with 10 reporting no history of LBP during a 15-minute ergometer trial using an electromagnetic tracking system. Adolescent male rowers with LBP reported increasing pain intensity during ergometer rowing. No significant differences were detected in mean upper or lower lumbar angles between rowers with and without LBP. However, compared with rowers without pain, rowers with pain: (1) had relatively less excursion of the upper lumbar spine into extension over the drive phase, (2) had relatively less excursion of the lower lumbar spine into extension over time, (3) had greater variability in upper and lower lumbar angles over the 15-minute ergometer trial, (4) positioned their upper lumbar spine closer to end range flexion for a greater proportion of the drive phase, and (5) showed increased time in sustained flexion loading in the upper lumbar spine. Differences in regional lumbar kinematics exist between adolescent male rowers with and without LBP, which may have injury implication and intervention strategies.

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