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VERTEBRAL ENDPLATE (MODIC) CHANGE IS AN INDEPENDENT RISK FACTOR FOR EPISODES OF SEVERE AND DISABLING LOW BACK PAIN

The Society for Back Pain Research (SBPR) - Annual General Meeting 2015



Abstract

Background and purpose of study:

Modic change (MC) describes vertebral endplate and bone marrow lesions visible on MRI. MC has been associated with disc degeneration (DD). Independent association of MC with low back pain (LBP) is unclear. The objectives of this study were to assess the relationship between MC and severe, disabling LBP; prevalence and features of DD and incident MC during 10-year follow-up.

Methods and results:

Unselected TwinsUK volunteers were recruited to MRI and nurse interview in 1996–2000 (n=823): a subset attended for follow-up a decade later (n=429). T2-weighted lumbar MR scans were coded blindly for MC, DD (loss of disc height and signal intensity, disc bulge and anterior osteophytes) and Schmorl's nodes (SN). Mean baseline age = 54.0 (32–70) years with 96% female. Prevalence of MC was 32.2% (baseline) and 48.7% (follow-up). Univariable analyses showed subjects having MC were older (p<0.001) and more overweight (p=0.026). At both timepoints subjects reporting severe LBP episodes demonstrated more MC (both p<0.001) than those without LBP. In multivariable analyses, MC remained significantly associated with episodes of severe, disabling LBP (OR 1.58; 95% CI 1.04–2.41) even after adjustment for age, BMI, DD and SN. Loss of disc height and disc signal intensity were independently associated with prevalent MC at baseline, and disc height and disc bulge with incident MC during follow-up.

Conclusions:

MC is associated with all disc features of DD but not anterior osteophytes. MC is an independent risk factor for episodes of severe and disabling LBP in middle-aged women.


Email:

No conflicts of interest.

Funding The MR imaging was funded by grants from Arthritis Research UK. TwinsUK is funded by the Wellcome Trust; European Community's Seventh Framework Programme (FP7/2007-2013). The study also received support from the National Institute for Health Research (NIHR) Clinical Research Facility and Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, and the Finnish Academy (Jaro Karppinen, project number 121620).