Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Health and Rehabilitation Sciences

Supervisor

Michele C. Battié

Abstract

Modic changes (MCs), defined as bone marrow lesions adjacent to the vertebral endplate seen on MRI, have been associated with back pain. There are different types of MCs, with different histopathological correlates. This community-based study sample comprised 110 men from the Twin Spine Study, with baseline, 5-year, and 15-year follow-up MRIs. Following training and reliability testing, 1320 endplates (T12-S1) were evaluated for MC presence, type, and dimensions at each time point. Results demonstrated that Type 2 Modic Changes (MC2) were the most common type, with approximately half located at the two lowest disc levels. However, Type 1 Modic Changes (MC1) were distributed similarly across the lumbar region. Results suggest that MC1 is a transient phase, with no MC1s at baseline persisting to 15-year follow-up, and most converting to MC2. New MCs mostly occurred in the anterior aspect of the endplate, which may provide clues related to pathogenesis.

Summary for Lay Audience

Low back pain is a common condition and the leading cause of disability worldwide, placing a heavy burden on affected individuals and society. Currently, the specific pathology underlying a vast majority (85%) of back pain remains unknown severely limiting the development of effective prevention and treatment approaches. Imaging biomarkers and phenotypes (observable traits) associated with LBP may help inform prognosis and provide insights into underlying pathology. In recent years there has been growing interest in one of these specific phenotypes, Modic changes (MCs), defined as bone marrow lesions adjacent to the vertebral endplate as seen on Magnetic Resonance Imaging (MRI). There are different types of MCs, and each has specific histopathological correlates. However, the natural course of these lesions, which this study aims to examine, is not well established.

This community-based study sample comprised 110 men (mean age of 48±8 years) from the Twin Spine Study cohort, shown to be highly representative of the corresponding Finnish population, with baseline, 5-year, and 15-year follow-up MRIs. Images were analyzed at three time points for all participants. Following training and reliability testing, images were evaluated for MC presence, type (MC1, MC2, or Mixed MC), and dimensions (anteroposterior, transverse, and vertical height) at each time point.

This longitudinal study confirmed that MC2 is the most common MC type in men, with MC2, but not other types, mainly located at the lower lumbar endplates. Also, MC1 appears to be a transient phase, with no MC1s at baseline persisting to 15-year follow-up. New MCs mostly occurred in the anterior aspect of the endplate, which may provide clues related to pathogenesis. Complete resolution of MCs can occur, but it is very uncommon.

Download

Share

COinS