Association between modic changes, disc degeneration, and pelvic incidence-lumbar lordosis mismatch in a large population based cohort: the Wakayama spine study

Masatoshi Teraguchi; Hiroshi Hashizume; Yoshiki Asai; Hiroyuki Oka; Keiji Nagata; Yuyu Ishimoto; Hiroshi Iwasaki; Shunji Tsutsui; Masanari Takami; Sakae Tanaka; Munehito Yoshida; Noriko Yoshimura; Hiroshi Yamada

doi:10.1007/s00586-023-07702-8

Association between modic changes, disc degeneration, and pelvic incidence-lumbar lordosis mismatch in a large population based cohort: the Wakayama spine study

Eur Spine J. 2023 Apr 26. doi: 10.1007/s00586-023-07702-8. Online ahead of print.

Authors

Affiliations

¹ Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan. m-tera@wakayama-med.ac.jp.
² Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan.
³ Department of Medical Research and Management for Musculoskeletal Pain, 22Nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan.
⁴ Department of Orthopaedic Surgery, The University of Tokyo, Bunkyoku, Tokyo, Japan.
⁵ Department of Orthopaedic Surgery, Sumiya Orthopaedic Hospital, Wakayama, Wakayama, Japan.
⁶ Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan.

PMID: 37100965
DOI: 10.1007/s00586-023-07702-8

Abstract

Purpose: Sagittal plane alignment is crucial for treating spinal malalignment and low back pain. Pelvic incidence-lumbar lordosis (PI-LL) mismatch is commonly used to evaluate clinical outcomes in patients with sagittal malalignment. The association between PI-LL mismatch and changes surrounding the intervertebral disc is very important to understand the compensatory mechanisms involved. This study aimed to examine the association between PI-LL mismatch and magnetic resonance imaging (MRI) changes surrounding the intervertebral disc in a large population-based cohort.

Methods: We evaluated participants from the second Wakayama Spine Study, recruiting the general population aged 20 years or older, irrespective of sex, who were registered residents in one region in 2014. In total, 857 individuals underwent an MRI of the whole spine; however, 43 MRI results were not included due to incomplete or inadequate quality images. PI-LL mismatch was defined as > 11°. We compared the MRI changes, such as Modic change (MC), disc degeneration (DD), and high-intensity zones (HIZ), between PI-LL mismatch and non-PI-LL mismatch groups. Multivariate logistic regression analysis was conducted to determine the association between the MRI changes and PI-LL mismatch with adjustment for age, sex, and body mass index in the lumbar region and at each level.

Results: A total of 795 participants (243 men, 552 women, mean age 63.5 ± 13.1 years old) were evaluated; 181 were included in the PI-LL mismatch group. MC and DD in the lumbar region were significantly higher in the PI-LL mismatch group. MC in the lumbar region was significantly associated with PI-LL mismatch (odds ratio (OR); 1.81, 95% confidence interval (CI) 1.2-2.7). MC at each level was significantly associated with PI-LL mismatch (OR; 1.7-1.9, 95%CI 1.1-3.2), and DD at L1/2, L3/4, and L4/5 was associated with PI-LL mismatch (OR; 2.0- 2.4. 95%CI 1.2-3.9).

Conclusion: MC and DD were significantly associated with PI-LL mismatch. Therefore, profiling MC may be helpful in improving the targeted treatment of LBP associated with the adult spinal deformity.

Keywords: Disc degeneration; Lumbar lordosis; Modic change; Pelvic incidence; Sagittal malalignment.