A Prospective, 3-year Longitudinal Study of Modic Changes of the Lumbar Spine in a Population-based Cohort: The Wakayama Spine Study

Hidenobu Tamai; Masatoshi Teraguchi; Hiroshi Hashizume; Hiroyuki Oka; Jason P Y Cheung; Dino Samartzis; Shigeyuki Muraki; Toru Akune; Hiroshi Kawaguchi; Kozo Nakamura; Sakae Tanaka; Munehito Yoshida; Noriko Yoshimura; Hiroshi Yamada

doi:10.1097/BRS.0000000000004301

A Prospective, 3-year Longitudinal Study of Modic Changes of the Lumbar Spine in a Population-based Cohort: The Wakayama Spine Study

Spine (Phila Pa 1976). 2022 Mar 15;47(6):490-497. doi: 10.1097/BRS.0000000000004301.

Authors

Affiliations

¹ Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan.
² Spine Care Center, Wakayama Medical University Kihoku Hospital, 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 Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China.
⁵ Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
⁶ Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
⁷ Department of Orthopedic Surgery, The University of Tokyo, Bunkyoku, Tokyo, Japan.
⁸ Department of Orthopedic Surgery, Sumiya Orthopedic Hospital, Wakayama City, Wakayama, Japan.

PMID: 35213525
DOI: 10.1097/BRS.0000000000004301

Abstract

Study design: Large-scale, prospective, population-based, longitudinal observational study.

Objective: The aim of this study was to investigate the rate of incidence, transformation, and reverse transformation of Modic changes (MCs) using T1-weighted (T1W) and T2-weighted (T2W) lumbar magnetic resonance images (MRI) over a 3-year period.

Summary of background data: Although MCs in populational study are considered significant, existing epidemiological evidence is based on cross-sectional studies only.

Methods: Overall, 678 subjects (208 men, 470 women, mean age 62.1 ± 12.8 years in 2013) in both 2013 and 2016 surveys were included. The rate of change in Modic Type I (T1W: low-intensity, T2W: high-intensity), Type II (T1W: high, T2W: high), and Type III (T1W: low, T2W: low) at five endplates was analyzed over a 3-year period. An incidence of MC at each level and in the lumbar region was defined as no MC at baseline with signal changes at follow-up. Transformation was defined as Type I or II MC at baseline with conversion at follow-up Type II from Type I or Type III MC from Type I and II. Furthermore, reverse transformation was defined as Type I, II, or III MC at baseline, with at least one endplate showing a reversion in Modic type (no MC for baseline Type I; no MC and Type I for baseline Type II; no MC, Type I or Type II for baseline Type III) at follow-up.

Results: Overall, 3390 endplates were included. For 3 years, the incidence, transformation, and reverse transformation of MCs were seen in 395 (11.7%), 84 (2.5%), and 11 (0.3%) endplates, respectively. The highest levels of incidence, transformation, and reverse transformation were at L2/3 (96 [14.2%] endplates), L5/S1 (32 [4.7%] endplates), and L2/3 (5 [0.7%] endplates), respectively.

Conclusion: This study revealed a high incidence of MCs at the upper lumbar levels and transformation at the lower lumbar levels. Reverse transformation of MCs occurs but are rare.Level of Evidence: 2.

Publication types

Observational Study

MeSH terms

Aged
Cross-Sectional Studies
Female
Humans
Intervertebral Disc Degeneration* / pathology
Longitudinal Studies
Lumbar Vertebrae / diagnostic imaging
Lumbar Vertebrae / pathology
Lumbosacral Region* / diagnostic imaging
Lumbosacral Region* / pathology
Magnetic Resonance Imaging / methods
Male
Middle Aged
Prospective Studies