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.
Panner’s Disease: The Vacuum Phenomenon Revisited