Intervertebral disc and vertebral endplate subchondral changes associated with Modic 1 changes of the lumbar spine: a cross-sectional study

Abstract

Background: Modic 1 changes are usually associated with degenerative disc disease (DDD). We aimed to compare Modic 1 changes with advanced degenerative disc disease (>50%-intervertebral space narrowing [IVSN]) to Modic 1 changes with less advanced lumbar degenerative disc disease (≤50%-IVSN).

Methods: We conducted a cross-sectional study. The computerized MRI database from a French tertiary care hospital was searched. Patients were included if they were ≥ 18 years old and had a lumbar MRI between January 1, 2006 and January 31, 2008, that showed a Modic 1 signal at a single level. The strength of the magnet was 1.5 T. MRI were reviewed by 2 assessors. Age and gender were recorded. MRI changes involving the intervertebral disc and the vertebral endplate subchondral bone were assessed for Modic 1 signal, intervertebral space narrowing, asymmetrical degenerative disc disease, spondylolisthesis, anterior and posterior intervertebral disc herniation, and anterior and lateral osteophytes. These outcomes were compared between >50%-IVSN Modic 1 and ≤50%-IVSN Modic 1 groups. For bivariate analysis, comparisons involved nonparametric Kruskal-Wallis test for quantitative variables and nonparametric Fisher's exact test for qualitative variables. Multivariate analysis was conducted to determine factors independently associated with <50%-IVSN Modic 1 changes by backward stepwise regression. Informed consent and formal approval from Institutional Review Board is not required for this type of study. This statement was confirmed by our Institutional Review Board.

Results: MRI for 101 individuals were eligible. Patients' mean (SD) age was 56.6(13.4) years, and 41/101(40.6%) were men. Modic 1 were most frequently observed at L4/L5 and L5/S1 (37[36.6%] cases each). As compared with >50%-IVSN Modic 1 patients, ≤50%-IVSN Modic 1 patients were younger (mean[SD] age 51.5[14.1] vs 58.8[12.6] years, p = 0.019), Modic 1 were more frequent at L5/S1 level (19[61.3%] vs 18[25.7%], p = 0.001), and anterior and lateral osteophytes were less frequent (13[41.9%] vs 55[78.6%], p < 0.001, and 11[35.5%] vs 48[68.6%], p = 0.002, respectively).

Conclusions: ≤50%-IVSN Modic 1 are rather found in young men at L5/S1 level and are associated with less frequent osteophytes than >50%-IVSN Modic, while >50%-IVSN Modic 1 are rather found in older women at L4/L5 level.

Keywords: Active discopathy; Degenerative disc disease; MRI; Modic 1; Vertebral endplate subchondral bone.

Figures

Fig. 1

Modic 1 changes width and height semi-quantitative scoring system. Modic 1 signal changes extending to the vertebral body were graded in the cranio-caudal axis for height and in the antero-posterior axis for width, based on the review of all slices, by using a semi-quantitative score ranging from 1 (edema involving  2/3 of the vertebral body)

Fig. 2

Flow chart of selection of lumbar MRI

Fig. 3

Examples of intervertebral space narrowing >50% intervertebral space narrowing (>50-IVSN) Modic 1 signal changes and ≤50%-IVSN Modic 1 changes on lumbar MRI. a >50%-IVSN Modic 1 changes in L5/S1 in a 52-year-old man. Decrease in intervertebral disc height was >50%, bone edema was present and extended to L5 and S1 vertebral bodies (white arrows) with hyperintense signal in T2-weighted sequence (left panel) and hypointense signal in T1-weighted sequence (right panel), and L5/S1 antelisthesis was observed (red arrow); b ≤50%-IVSN Modic 1 signal changes in L5/S1 in a 35-year-old woman. Decrease in intervertebral disc height was <50%, edema extended to L5 and S1 vertebral endplates (white arrows) with hyperintense signal in T2-weighted sequence (left panel) and hypointense signal in T1-weighted sequence (right panel), and posterior disc protrusion was observed (red arrow). L4/L5 lumbar DDD was also present