Pulsiones

SPINE Volume 36, Number 26, pp 2304–2307 ©2011, Lippincott Williams & Wilkins

DIAGNOSTICS

Modic Vertebral Body Changes
The Natural History as Assessed by Consecutive Magnetic Resonance Imaging
Michael J. Hutton, FRCS (Tr & Orth),* Jens H. Bayer, MD, FRCS (Tr & Orth),† John M. Powell, FRCS,† and David J. Sharp, FRCS†

Study Design. Changes in the vertebral body adjacent to the end plate may beassociated with degenerative disc disease. These changes can be separated on magnetic resonance imaging (MRI) and have been described by Modic. It is assumed that these end plate changes represent a process that is progressive. Objective. We have retrospectively reviewed patients who had sequential MRI of the lumbar spine to investigate the natural history of Modic vertebral body MRI changes.Summary of Background Data. Of 36 end plates with Modic type 1 changes in a first MRI, 18 remained the same, 13 progressed to Modic type 2 change, 3 progressed to Modic type 3 changes, and 2 end plates were found to be normal (type 0) on a subsequent MRI. Of the 22 end plates initially reported as Modic type 2 in a first MRI, 18 remained unchanged, none converted to Modic type 3, and 4 converted fromModic type 2 to Modic type 1 on a subsequent MRI. Methods. Magnetic resonance (MR) images of the lumbar spine of 49 subjects were assessed by a senior spinal surgeon. The lumbar vertebral body adjacent to the end plate was classified by using the Modic system from L1 to S1 inclusive. Results. Of the 36 end plates with Modic 1 changes in the first data set, 18 remained the same; 13 progressed to Modic2; 3 progressed to Modic 3 changes, and, interestingly, 2 end plates were found to be normal on the repeat scan. Of the 22 end plates initially reported as Modic 2, 18 remained unchanged; none converted to Modic 3 and 4 converted back from Modic 2 to Modic 1. Conclusion. Our findings reflect the dynamic nature of pathological changes in the spine and have demonstrated that Modic changes arereversible. They also raise further doubt that these MRI changes should be used as an indicator of clinical symptoms or of surgical outcome.
From the *Princess Elisabeth Orthopaedic Centre, Royal Devon & Exeter Hospital, Exeter, United Kingdom, and †Spinal Unit, Department of Orthopaedic and Trauma Surgery, Ipswich Hospital, Ipswich, United Kingdom. Acknowledgement: November 16, 2005. First revision date:April 16, 2006. Second revision date: November 27, 2006. Third revision date: January 28, 2007. Fourth Revision date: December 9, 2010. Accepted date: December 15, 2010. The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directlyor indirectly to the subject of this manuscript. Address correspondence and reprint requests to Michael J. Hutton, FRCS (Tr & Orth), Princess Elisabeth Orthopaedic Centre, Royal Devon & Exeter Hospital, Barrack Rd, Exeter, United Kingdom, EX2 5DW; E-mail: mikehutton@me.com DOI: 10.1097/BRS.0b013e31821604b6

Key words: lumbar MRI, Modic changes, natural history. Spine 2011;36:2304–2307

hanges inthe vertebral body adjacent to the end plate may be associated with degenerative disc disease. These were described by Modic1 in 1988. The changes were first classified into 2 types. Type 1 changes include decreased signal intensity on T1-weighted and increased signal intensity on T2-weighted images (Figure 1). Type 2 changes include increased signal intensity in T1-weighted images and increased orisointense signal intensity on T2-weighted images (Figure 2). After histological studies by Modic,1 type 1 changes are assumed to be a result of fibrovascular replacement of subchondral bone and type 2 changes are the manifestation of fatty replacement of subchondral bone and are considered to be chronic. These changes can be separated only on magnetic resonance imaging (MRI). If bone sclerosis is...