PET imaging in patients with Modic changes

2009 ◽  
Vol 48 (03) ◽  
pp. 110-112 ◽  
Author(s):  
H. Petersen ◽  
C. Manniche ◽  
P. F. Høilund-Carlsen ◽  
H. B. Albert
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pet Imaging ◽  
Lumbar Disc ◽  
Modic Changes ◽  
Herniated Disc ◽  
Low Back ◽  
Modic Type ◽  
Magnetic Resonance Imaging Mri

SummaryThe aim of this study was via PET imaging to reveal if any highly metabolic processes were occurring in Modic changes type 1 and/or in the adjacent discs. Modic changes (MC) are signal changes in the vertebral endplate and body visualised by magnetic resonance imaging (MRI). MC are strongly associated with low back pain (LBP). MC type 1 appear to be inflammation on MRI, and histological and biochemical findings make it highly likely that an inflammation is present. Though MC is painful no known treatment is available, and it is unknown which entities affect the progress or regress of MC. The changes observed on MRI are slow and take months to develop, but faster changes in the metabolism might provide a platform for monitoring patients. Patients, methods: Patients from The Back Centre Funen, with low back pain in the area of L1 to S1, MC type 1 in L1 to L5, and a previous herniated lumbar disc. All patients had a PET scan using FDG (18F-fluorodeoxyglucose) as tracer. Results: Included in the study were 11 patients, 4 women and 7 men, mean age 48.1 year (range 20–65). All MC were situated in the vertebrae both above and below the previously herniated disc/discs. Ten patients had MC at 1 level, and 1 had MC at 2 levels. The affected levels were 1 at L2/L3, 6 at L4 /L5, and 5 at L5/S1. All had a previous disc herniation and MC larger than 4 mm in diameter. Technically satisfactory PET scans were obtained. However, PET imaging showed no increases in metabolism in any vertebra or disc of any patient. Conclusion: Modic type 1 changes do not reveal themselves by showing increased metabolism with ordinary FDG PET imaging. PET tracers illuminating inflammation are being developed and hopefully may become more successful.

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.

Reverse transformation of Modic Type 2 changes to Modic Type 1 changes during sustained chronic low-back pain severity

2007 ◽  
Vol 6 (2) ◽  
pp. 152-155 ◽  
Author(s):  
Laurence A. G. Marshman ◽  
Matthew Trewhella ◽  
Tai Friesem ◽  
Chandra K. Bhatia ◽  
Manoj Krishna
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Reverse Transformation ◽  
Pain Severity ◽  
Low Back ◽  
Modic Type ◽  
Generating Capacity

✓Modic Type 2 (MT2) neuroimaging changes are considered stable or invariant over time and relatively quiescent, whereas Modic Type 1 (MT1) changes are considered unstable and more symptomatic. The authors report two cases in which MT2 changes were symptomatic and evidently unstable, and in which chronic low-back pain severity remained unaltered despite a MT2–MT1 reverse transformation. Two women (41 and 48 years old) both presented with chronic low-back pain. Magnetic resonance (MR) images demonstrated degenerating discs at L5–S1 associated with well-established MT2 changes in adjacent vertebrae. Repeated MR imaging in these two patients after 11 months and 7 years, respectively, revealed reverse transformation of the MT2 changes into more florid MT1 changes, despite unaltered chronic low-back pain severity. Following anterior discectomy and disc arthroplasty, immediate abolition of chronic low-back pain was achieved in both patients and sustained at 3-year follow up. Modic Type 2 changes are therefore neither as stable nor as quiescent as originally believed. Each type can change, with equal symptom-generating capacity. More representative imaging–pathological correlates are required to determine the precise nature of MT changes.

scholarly journals Short-term pain evolution in chronic low back pain with Modic type 1 changes treated by a lumbar rigid brace: A retrospective study

2019 ◽  
Vol 62 (1) ◽  
pp. 3-7 ◽  
Author(s):  
Laura Boutevillain ◽  
Armand Bonnin ◽  
Aurore Chabaud ◽  
Claire Morel ◽  
Mathias Giustiniani ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Retrospective Study ◽  
Chronic Low Back Pain ◽  
Low Back ◽  
Short Term ◽  
Modic Type

scholarly journals Macrophage migration inhibitory factor: a potential biomarker for chronic low back pain in patients with Modic changes

RMD Open ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. e001726
Author(s):  
Elisabeth Gjefsen ◽  
Kristina Gervin ◽  
Guro Goll ◽  
Lars Christian Haugli Bråten ◽  
Monica Wigemyr ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Migration Inhibitory Factor ◽  
Macrophage Migration Inhibitory Factor ◽  
Modic Changes ◽  
Macrophage Migration ◽  
Healthy Controls ◽  
Low Back

BackgroundLow back pain (LBP) is a leading cause of disability worldwide, but the aetiology remains poorly understood. Finding relevant biomarkers may lead to better understanding of disease mechanisms. Patients with vertebral endplate bone marrow lesions visualised on MRI as Modic changes (MCs) have been proposed as a distinct LBP phenotype, and inflammatory mediators may be involved in the development of MCs.ObjectivesTo identify possible serum biomarkers for LBP in patients with MCs.MethodsIn this case control study serum levels of 40 cytokines were compared between patients with LBP and MC type 1 (n=46) or type 2 (n=37) and healthy controls (n=50).ResultsAnalyses identified significantly higher levels of six out of 40 cytokines in the MC type 1 group (MC1), and five in the MC type 2 group (MC2) compared with healthy controls. Six cytokines were moderately correlated with pain. Principal component analyses revealed clustering and separation of patients with LBP and controls, capturing 40.8% of the total variance, with 10 cytokines contributing to the separation. Macrophage migration inhibitory factor (MIF) alone accounted for 92% of the total contribution. Further, receiver operating characteristics analysis revealed that MIF showed an acceptable ability to distinguish between patients and controls (area under the curve=0.79).ConclusionsThese results suggest that cytokines may play a role in LBP with MCs. The clinical significance of the findings is unknown. MIF strongly contributed to clustering of patients with LBP with MCs and controls, and might be a biomarker for MCs. Ultimately, these results may guide future research on novel treatments for this patient group.

scholarly journals Full-endoscopic Spine Surgery for Discogenic Low Back Pain with High-intensity Zones and Modic Type 1 Change in a Professional Baseball Player

2021 ◽  
Vol 8 (1) ◽  
pp. 587-593
Author(s):  
Daiki NAKAJIMA ◽  
Kazuta YAMASHITA ◽  
Makoto TAKEUCHI ◽  
Kosuke SUGIURA ◽  
Masatoshi MORIMOTO ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
High Intensity ◽  
Professional Baseball ◽  
Baseball Player ◽  
Low Back ◽  
Endoscopic Spine Surgery ◽  
Discogenic Low Back Pain ◽  
Modic Type

scholarly journals SubclinicalPropionibacterium acnesinfection estimation in the intervertebral disc (SPInE-ID): protocol for a prospective cohort

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e017930 ◽  
Author(s):  
Nelson Astur ◽  
Delio E Martins ◽  
Marcelo Wajchenberg ◽  
Mario Ferretti ◽  
Fernando G Menezes ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Intervertebral Disc ◽  
Prospective Cohort ◽  
Lumbar Disc ◽  
Herniated Disc ◽  
Decompression Surgery ◽  
Low Back ◽  
Informed Consent Form ◽  
Study Results

IntroductionLow back pain and vertebral endplate abnormalities are common conditions within the population. Subclinical infection caused by indolent pathogens can potentially lead to these findings, with differentiation between them notably challenging from a clinical perspective. Progressive infection of the intervertebral disc has been extensively associated with increasing low back pain, withPropionibacterium acnesspecifically implicated with in relation to sciatica. The main purpose of this study is to identify if the presence of an infective pathogen within the intervertebral disc is primary or is a result of intraoperative contamination, and whether this correlates to low back pain.Methods and analysisAn open prospective cohort study will be performed. Subjects included within the study will be between the ages of 18 and 65 years and have a diagnosis of lumbar disc herniation requiring open decompression surgery. Excised herniated disc fragments, muscle and ligamentum flavum samples will be collected during surgery and sent to microbiology for tissue culture and pathogen identification. Score questionnaires for pain, functionality and quality of life will be given preoperatively and at 1, 3, 6 and 12 months postoperatively. A MRI will be performed 12 months after surgery for analysis of Modic changes and baseline comparison. The primary endpoint is the rate of disc infection in patients with symptomatic degenerative disc disease. The secondary endpoints will be performance scores, Modic incidence and volume.Ethics and disseminationThis study was approved by our Institutional Review Board and was only initiated after it (CAAE 65102617.2.0000.0071). Patients agreeing to participate will sign an informed consent form before entering the study. Results will be published in a peer reviewed medical journal irrespective of study findings. If shown to be the case, this would have profound effects on the way physicians treat chronic low back pain, even impacting health costs.Trials registration numberNCT0315876; Pre-results.

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