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2016 ; 25
(11
): 3723-3734
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Pathobiology of Modic changes
#MMPMID26914098
Dudli S
; Fields AJ
; Samartzis D
; Karppinen J
; Lotz JC
Eur Spine J
2016[Nov]; 25
(11
): 3723-3734
PMID26914098
show ga
PURPOSE: Low back pain (LBP) is the most disabling condition worldwide. Although
LBP relates to different spinal pathologies, vertebral bone marrow lesions
visualized as Modic changes on MRI have a high specificity for discogenic LBP.
This review summarizes the pathobiology of Modic changes and suggests a disease
model. METHODS: Non-systematic literature review. RESULTS: Chemical and
mechanical stimulation of nociceptors adjacent to damaged endplates are likely a
source of pain. Modic changes are adjacent to a degenerated intervertebral disc
and have three generally interconvertible types suggesting that the different
Modic change types represent different stages of the same pathological process,
which is characterized by inflammation, high bone turnover, and fibrosis. A
disease model is suggested where disc/endplate damage and the persistence of an
inflammatory stimulus (i.e., occult discitis or autoimmune response against disc
material) create predisposing conditions. The risk to develop Modic changes
likely depends on the inflammatory potential of the disc and the capacity of the
bone marrow to respond to it. Bone marrow lesions in osteoarthritic knee joints
share many characteristics with Modic changes adjacent to degenerated discs and
suggest that damage-associated molecular patterns and marrow fat metabolism are
important pathogenetic factors. There is no consensus on the ideal therapy.
Non-surgical treatment approaches including intradiscal steroid injections,
anti-TNF-? antibody, antibiotics, and bisphosphonates have some demonstrated
efficacy in mostly non-replicated clinical studies in reducing Modic changes in
the short term, but with unknown long-term benefits. New diagnostic tools and
animal models are required to improve painful Modic change identification and
classification, and to clarify the pathogenesis. CONCLUSION: Modic changes are
likely to be more than just a coincidental imaging finding in LBP patients and
rather represent an underlying pathology that should be a target for therapy.
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