Jialong Wu1, Jiawei Huang1, Michele C Battié2, Yue Wang3. 1. Department of Orthopedic Surgery, Spine Lab, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China. 2. Department of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada. 3. Department of Orthopedic Surgery, Spine Lab, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China. Electronic address: wangyuespine@zju.edu.cn.
Abstract
BACKGROUND CONTEXT: Modic changes (MCs) have long been suspected as a pathologic cause of back pain. Although much attention has been focused on clinical perspectives, the etiology of MCs remains unclear. Although some studies have reported that sex, body mass index (BMI), cigarette smoking, and physical loading may associate with MCs, the observed associations are inconsistent among studies. PURPOSE: To investigate associations between MCs and lifestyle and lifetime occupational exposures using a general population sample. STUDY DESIGN: Cross-sectional study. PATIENT SAMPLE: The study was an extension of the Hangzhou Lumbar Spine Study, a population-based study of mainland Chinese focusing on lumbar degenerative changes. A total of 644 randomly selected subjects from a typical community in Hangzhou, Eastern China participated. OUTCOME MEASURES: The presence and type of MCs in the lumbosacral spine were evaluated on sagittal magnetic resonance images. Demographics, lifestyle factors, and occupational exposures were measured using a structured interview. METHODS: Univariate and multivariate logistic regressions were used to examine the associations of MCs with various environmental exposures. RESULTS: Among the 644 subjects (52.6±13.9 years; range 20-88 years) included in this study, 44.7% had MCs. In univariate regression analyses, the presence of MCs was associated with greater age, higher BMI, greater cigarette smoking, regular exercise, and absence of daily vehicle vibration. Modic changes were not univariately associated with sex or alcohol consumption. In addition, all occupational loading measurements were associated with the occurrence of MCs in univariate analyses, except work time spent in vehicles and work-related back injuries. However, in multivariate regression analyses, no statistically significant associations between the occurrence of MCs and lifestyle or lifetime occupational exposures were observed after adjusting for age, sex, and BMI. CONCLUSIONS: Age is an important determinant of MCs, with BMI and sex also playing a role. Lifestyle and occupational factors appear to have minor effects, if any, on the pathogenesis of MCs in the lumbar spine.
BACKGROUND CONTEXT: Modic changes (MCs) have long been suspected as a pathologic cause of back pain. Although much attention has been focused on clinical perspectives, the etiology of MCs remains unclear. Although some studies have reported that sex, body mass index (BMI), cigarette smoking, and physical loading may associate with MCs, the observed associations are inconsistent among studies. PURPOSE: To investigate associations between MCs and lifestyle and lifetime occupational exposures using a general population sample. STUDY DESIGN: Cross-sectional study. PATIENT SAMPLE: The study was an extension of the Hangzhou Lumbar Spine Study, a population-based study of mainland Chinese focusing on lumbar degenerative changes. A total of 644 randomly selected subjects from a typical community in Hangzhou, Eastern China participated. OUTCOME MEASURES: The presence and type of MCs in the lumbosacral spine were evaluated on sagittal magnetic resonance images. Demographics, lifestyle factors, and occupational exposures were measured using a structured interview. METHODS: Univariate and multivariate logistic regressions were used to examine the associations of MCs with various environmental exposures. RESULTS: Among the 644 subjects (52.6±13.9 years; range 20-88 years) included in this study, 44.7% had MCs. In univariate regression analyses, the presence of MCs was associated with greater age, higher BMI, greater cigarette smoking, regular exercise, and absence of daily vehicle vibration. Modic changes were not univariately associated with sex or alcohol consumption. In addition, all occupational loading measurements were associated with the occurrence of MCs in univariate analyses, except work time spent in vehicles and work-related back injuries. However, in multivariate regression analyses, no statistically significant associations between the occurrence of MCs and lifestyle or lifetime occupational exposures were observed after adjusting for age, sex, and BMI. CONCLUSIONS: Age is an important determinant of MCs, with BMI and sex also playing a role. Lifestyle and occupational factors appear to have minor effects, if any, on the pathogenesis of MCs in the lumbar spine.
Authors: Yiming Li; Jaro Karppinen; Kathryn S E Cheah; Danny Chan; Pak C Sham; Dino Samartzis Journal: Eur Spine J Date: 2021-09-25 Impact factor: 3.134