Year: 2024
Type: article
Abstract: First described in 1988, Modic changes are MRI findings in the lumbar spine that are present in a substantial fraction -approximately 43% -of patients with back pain, and are thought to reflect pathobiological states characterized by combinations of inflammation, bone turnover, and fibrosis.1 2 3 Three subtypes of Modic changes are delineated by their characteristic appearance on MRI, but multiple types may coexist in any individual patient, and lesions may progress between types over time.Type 1 changes are hypointense on T1-weighted sequences and hyperintense on T2-weighted sequences, type 2 changes are hyperintense on T1-weighted sequences and hyper-or isointense on T2-weighted sequences, and type 3 changes are hypointense on both T1-and T2-weighted images.1,2 Similar MRI changes have been described in other locations and other diseases, where they have received different names.For example, in axial spondyloarthritis, bone marrow lesions that are hypointense on T1-weighted sequences and hyperintense on T2-weighted (equivalent to Modic type 1 changes) are called bone marrow edema and are considered to represent active inflammatory lesions.4 Histopathological studies of Modic changes have been sparse.2 Type 1 Modic changes may reflect an active bone turnover state accompanied by increased pain signaling and nerve fiber density in the vertebra.5 As a result, type 1 changes represent a clinically important target for potential intervention.5 Controversy has surrounded the primary stimulus that leads to Modic changes and the optimal management of patients who exhibit these findings.Some evidence has supported a potential role for an infectious catalyst, 6 but trials of antibiotics have yielded mixed results.7 Many researchers believe that Modic changes begin with increased load on the vertebra initializing a sequence of endplate damage, disc herniation into the endplate, a repair response to the herniation, and changes in tissue-level cytokine expression including upregulation of inflammatory mediators including tumor necrosis factor (TNF). 5 Several key findings have led to the hypothesis that Modic type 1 changes are largely inflammatory in nature and may respond to anti-inflammatory treatment, including TNF inhibitors.TNF-immunoreactive cells are more densely populated in endplates with type 1
Source: Arthritis & Rheumatology
DOI: 10.1002/art.43068
Institutions: Brigham and Women's Hospital, Harvard University
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4404908982