Relationship of Modic type 1 change with disc degeneration: a prospective MRI study
From: Skeletal Radiol. 2008 Dec 19; [Epub ahead of print]
The objective was to study the natural course of Modic type 1 change in relation to lumbar disc degeneration. Twenty-four chronic low back pain patients with Modic type 1 change on lumbar spine were selected from 1,015 patients with magnetic resonance imaging from a follow-up study lasting for 18-74 months. Exclusion criteria were any other specific back disorder, age greater than or equal to 60 years, or a recent spine operation. The association between the development of Modic type 1 change and degenerative disc changes was studied using multivariate modeling.
At baseline, 20 of 28 (71%) disc spaces with Modic type 1 change had a decreased disc height and 16 of 28 (57%) a dark nucleus pulposus, but ten of 28 (36%) a very dark annulus fibrosus and a paradoxically bright nucleus pulposus albeit decreased decreased disc height. During follow-up, decreased disc height decreased in 13 of 28 (46%) and signal intensity of nucleus pulposus in eight of 28 (29%) disc spaces with Modic type 1 change, but it increased in four (14%) discs. In those without Modic type 1 change, only few changes occurred. The larger the Modic type 1 change, the more likely was the decreased disc height low or decreased further. Both the presence and changes in Modic type 1 change were associated with a decrease in decreased disc height and changes in signal intensity of nucleus pulposus and bulges.
The degenerative process in discs with adjacent Modic type 1 change seems to be accelerated and leads to advanced and deforming changes with special morphologic features. Modic type 1 change may be a sign of a pathologic degenerative process in the discovertebral unit.
