Hidenobu Tamai1, Masatoshi Teraguchi2, Hiroshi Hashizume1, Hiroyuki Oka3, Jason P Y Cheung4, Dino Samartzis5, Shigeyuki Muraki6, Toru Akune6, Hiroshi Kawaguchi6, Kozo Nakamura7, Sakae Tanaka6, Munehito Yoshida8, Noriko Yoshimura6, Hiroshi Yamada1. 1. Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan. 2. Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan. 3. Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan. 4. Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China. 5. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL. 6. Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan. 7. Department of Orthopedic Surgery, The University of Tokyo, Bunkyoku, Tokyo, Japan. 8. Department of Orthopedic Surgery, Sumiya Orthopedic Hospital, Wakayama City, Wakayama, Japan.
Abstract
STUDY DESIGN: Large-scale, prospective, population-based, longitudinal observational study. OBJECTIVE: The aim of this study was to investigate the rate of incidence, transformation, and reverse transformation of Modic changes (MCs) using T1-weighted (T1W) and T2-weighted (T2W) lumbar magnetic resonance images (MRI) over a 3-year period. SUMMARY OF BACKGROUND DATA: Although MCs in populational study are considered significant, existing epidemiological evidence is based on cross-sectional studies only. METHODS: Overall, 678 subjects (208 men, 470 women, mean age 62.1 ± 12.8 years in 2013) in both 2013 and 2016 surveys were included. The rate of change in Modic Type I (T1W: low-intensity, T2W: high-intensity), Type II (T1W: high, T2W: high), and Type III (T1W: low, T2W: low) at five endplates was analyzed over a 3-year period. An incidence of MC at each level and in the lumbar region was defined as no MC at baseline with signal changes at follow-up. Transformation was defined as Type I or II MC at baseline with conversion at follow-up Type II from Type I or Type III MC from Type I and II. Furthermore, reverse transformation was defined as Type I, II, or III MC at baseline, with at least one endplate showing a reversion in Modic type (no MC for baseline Type I; no MC and Type I for baseline Type II; no MC, Type I or Type II for baseline Type III) at follow-up. RESULTS: Overall, 3390 endplates were included. For 3 years, the incidence, transformation, and reverse transformation of MCs were seen in 395 (11.7%), 84 (2.5%), and 11 (0.3%) endplates, respectively. The highest levels of incidence, transformation, and reverse transformation were at L2/3 (96 [14.2%] endplates), L5/S1 (32 [4.7%] endplates), and L2/3 (5 [0.7%] endplates), respectively. CONCLUSION: This study revealed a high incidence of MCs at the upper lumbar levels and transformation at the lower lumbar levels. Reverse transformation of MCs occurs but are rare.Level of Evidence: 2.
STUDY DESIGN: Large-scale, prospective, population-based, longitudinal observational study. OBJECTIVE: The aim of this study was to investigate the rate of incidence, transformation, and reverse transformation of Modic changes (MCs) using T1-weighted (T1W) and T2-weighted (T2W) lumbar magnetic resonance images (MRI) over a 3-year period. SUMMARY OF BACKGROUND DATA: Although MCs in populational study are considered significant, existing epidemiological evidence is based on cross-sectional studies only. METHODS: Overall, 678 subjects (208 men, 470 women, mean age 62.1 ± 12.8 years in 2013) in both 2013 and 2016 surveys were included. The rate of change in Modic Type I (T1W: low-intensity, T2W: high-intensity), Type II (T1W: high, T2W: high), and Type III (T1W: low, T2W: low) at five endplates was analyzed over a 3-year period. An incidence of MC at each level and in the lumbar region was defined as no MC at baseline with signal changes at follow-up. Transformation was defined as Type I or II MC at baseline with conversion at follow-up Type II from Type I or Type III MC from Type I and II. Furthermore, reverse transformation was defined as Type I, II, or III MC at baseline, with at least one endplate showing a reversion in Modic type (no MC for baseline Type I; no MC and Type I for baseline Type II; no MC, Type I or Type II for baseline Type III) at follow-up. RESULTS: Overall, 3390 endplates were included. For 3 years, the incidence, transformation, and reverse transformation of MCs were seen in 395 (11.7%), 84 (2.5%), and 11 (0.3%) endplates, respectively. The highest levels of incidence, transformation, and reverse transformation were at L2/3 (96 [14.2%] endplates), L5/S1 (32 [4.7%] endplates), and L2/3 (5 [0.7%] endplates), respectively. CONCLUSION: This study revealed a high incidence of MCs at the upper lumbar levels and transformation at the lower lumbar levels. Reverse transformation of MCs occurs but are rare.Level of Evidence: 2.
Authors: Mark J Lambrechts; Parker Brush; Tariq Z Issa; Gregory R Toci; Jeremy C Heard; Amit Syal; Meghan M Schilken; Jose A Canseco; Christopher K Kepler; Alexander R Vaccaro Journal: Int J Environ Res Public Health Date: 2022-08-16 Impact factor: 4.614