Skip to main content

Advertisement

SpringerLink
Log in

Are Modic changes prognostic for recovery in a cohort of patients with non-specific low back pain?

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Background

There is evidence for an association between Modic type 1 and pain in patients with low back pain (LBP), but little knowledge about its effect on clinical outcomes.

Purpose

(1) To assess the prevalence of Modic changes, (2) to determine if Modic changes influence the clinical course of LBP, and (3) to identify prognostic factors for recovery.

Study design/setting

Prospective clinical cohort study, with a 1-year follow-up. The treatment consisted of brief intervention and instruction in stretching.

Patient’s sample

Two hundred and sixty-nine patients with chronic low back pain.

Outcome measures

Socio-demographic variables, education, profession, self-reported measures, degenerative changes on MRI.

Methods

Linear growth model and Cox regression analysis.

Results

Five percent had a normal MRI, 14 and 50% had Modic 1 and Modic 2 changes. Modic changes were not significant covariates for the clinical course of pain, function or fear avoidance beliefs. Education was a strong prognostic factor for recovery.

Conclusions

Modic changes did not influence the clinical course of back pain and were not prognostic factors for recovery. Education was strongly associated with recovery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G (2006) Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 15(Suppl 2):S192–S300

    Article  PubMed  Google Scholar 

  2. Waddell G (1987) 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain. Spine 12(7):632–644

    Article  PubMed  CAS  Google Scholar 

  3. Sheehan NJ (2010) Magnetic resonance imaging for low back pain: indications and limitations. Ann Rheum Dis 69(1):7–11

    PubMed  CAS  Google Scholar 

  4. Jensen TS, Karppinen J, Sorensen JS, Niinimaki J, Leboeuf-Yde C (2008) Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J 17(11):1407–1422

    Article  PubMed  Google Scholar 

  5. Burke JG, Watson RW, McCormack D, Dowling FE, Walsh MG, Fitzpatrick JM (2002) Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. J Bone Joint Surg Br 84(2):196–201

    Article  PubMed  CAS  Google Scholar 

  6. Schmid G, Witteler A, Willburger R, Kuhnen C, Jergas M, Koester O (2004) Lumbar disk herniation: correlation of histologic findings with marrow signal intensity changes in vertebral endplates at MR imaging. Radiology 231(2):352–358

    Article  PubMed  Google Scholar 

  7. Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166(1 Pt 1):193–199

    PubMed  CAS  Google Scholar 

  8. Holtermann A, Hansen JV, Burr H, Sogaard K (2010) Prognostic factors for long-term sickness absence among employees with neck-shoulder and low-back pain. Scand J Work Environ Health 36(1):34–41

    Article  PubMed  Google Scholar 

  9. Carrino JA, Lurie JD, Tosteson AN, Tosteson TD, Carragee EJ, Kaiser J, Grove MR, Blood E, Pearson LH, Weinstein JN, Herzog R (2009) Lumbar spine: reliability of MR imaging findings. Radiology 250(1):161–170. doi:10.1148/radiol.2493071999

    Article  PubMed  Google Scholar 

  10. Revised International Standard Classification of Occupations: (ISCO-88) (1987) [S.I]: International Labour Office, Bureau of Statistics

  11. Farrar JT, Pritchett YL, Robinson M, Prakash A, Chappell A (2010) The clinical importance of changes in the 0 to 10 numeric rating scale for worst, least, and average pain intensity: analyses of data from clinical trials of duloxetine in pain disorders. J Pain 11(2):109–118

    Article  PubMed  CAS  Google Scholar 

  12. Roland M, Fairbank J (2000) The Roland-Morris disability questionnaire and the Oswestry disability questionnaire. Spine 25(24):3115–3124

    Article  PubMed  CAS  Google Scholar 

  13. Grotle M, Brox JI, Vollestad NK (2006) Reliability, validity and responsiveness of the fear-avoidance beliefs questionnaire: methodological aspects of the Norwegian version. J Rehabil Med 38(6):346–353. doi:10.1080/16501970600722403

    Article  PubMed  Google Scholar 

  14. Eriksen HR, Ihlebaek C, Ursin H (1999) A scoring system for subjective health complaints (SHC). Scand J Public Health 27(1):63–72

    Article  PubMed  CAS  Google Scholar 

  15. West B, Welch K, Galecki A (2006) Linear mixed models: a practical guide using statistical software. Chapman Hall/CRC Press, London

  16. Rothman K, Greenland S, Lash T (2008) Modern epidemiology, 1st edn. Lippincott Williams & Wilkins, Boston

    Google Scholar 

  17. Hayden JA, Dunn KM, van der Windt DA, Shaw WS (2010) What is the prognosis of back pain? Best Pract Res Clin Rheumatol 24(2):167–179

    Article  PubMed  CAS  Google Scholar 

  18. Chibnall JT, Tait RC (2009) Long-term adjustment to work-related low back pain: associations with socio-demographics, claim processes, and post-settlement adjustment. Pain Med 10(8):1378–1388

    Article  PubMed  Google Scholar 

  19. Modic MT, Ross JS (2007) Lumbar degenerative disk disease. Radiology 245(1):43–61

    Article  PubMed  Google Scholar 

  20. Kuisma M, Karppinen J, Niinimaki J, Kurunlahti M, Haapea M, Vanharanta H, Tervonen O (2006) A three-year follow-up of lumbar spine endplate (Modic) changes. Spine 31(15):1714–1718

    Article  PubMed  Google Scholar 

  21. Beresford ZM, Kendall RW, Willick SE (2010) Lumbar facet syndromes. Curr Sports Med Rep 9(1):50–56

    PubMed  Google Scholar 

  22. Health literacy and the Millennium (2010) Development goals: United Nations Economic and Social Council (ECOSOC) regional meeting background paper (abstracted). J Health Commun 15(Suppl 2):211–223. doi:10.1080/10810730.2010.499996

  23. Services USDoHaH (2000) Healthy people 2010, understanding and improving health. Washington, DC, US Government Printing Office

  24. Altman DG, Lyman GH (1998) Methodological challenges in the evaluation of prognostic factors in breast cancer. Breast Cancer Res Treat 52(1–3):289–303

    Article  PubMed  CAS  Google Scholar 

  25. Guyatt G, Jaeschke R, Heddle N, Cook D, Shannon H, Walter S (1995) Basic statistics for clinicians: 2. Interpreting study results: confidence intervals. CMAJ 152(2):169–173

    PubMed  CAS  Google Scholar 

  26. Maughan EF, Lewis JS (2010) Outcome measures in chronic low back pain. Eur Spine J 19(9):1484–1494. doi:10.1007/s00586-010-1353-6

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors wish to acknowledge Dr. Sophie Soklaridis, Research Manager, Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada for constructive criticism during preparation of this manuscript. We also acknowledge the assistance of Marianne Landa, MRI-technologist, Section of Neuroradiology, Oslo University Hospital, Ullevaal Oslo, Norway.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0407, Oslo, Norway

    Anne Keller & Erik Bautz-Holter

  2. Division of Health Care and Outcomes Research, University Health Network, Toronto, Canada

    Eleanor Boyle & J. David Cassidy

  3. Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

    Eleanor Boyle

  4. Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

    J. David Cassidy

  5. Department of Neuroradiology, Oslo University Hospital, Oslo, Norway

    Thomas A. Skog

Authors
  1. Anne Keller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eleanor Boyle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas A. Skog
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. David Cassidy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Erik Bautz-Holter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anne Keller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Keller, A., Boyle, E., Skog, T.A. et al. Are Modic changes prognostic for recovery in a cohort of patients with non-specific low back pain?. Eur Spine J 21, 418–424 (2012). https://doi.org/10.1007/s00586-011-1964-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-011-1964-6

Keywords

Search

Navigation