Vertebral endplate signal changes (Modic changes): prevalence, development over time and association with back pain

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1 Vertebral endplate signal changes (Modic changes): prevalence, development over time and association with back pain Tue Secher Jensen, Senior Research Fellow, MSc (Clin. Biomech.), PhD 1,2 Rikke Krüger Jensen, Postdoc, MSc (Clin. Biomech.), PhD 1 1 The Spine Centre of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Services Research, University of Southern Denmark 2 Nordic Institute of Chiropratic and Clinical Biomechanics, Odense, Denmark Financial support: The Foundation for Chiropractic Research and Postgraduate Education and Velux Foundation

2

3 Subjects of this talk Prevalence of Modic changes Development over time Association between Modic changes and low back pain Cross-sectionally Longitudinally

4 Prevalence

5 Prevalence Clinical >> non-clinical Prevalence Non-clinical Clinical 1 Jensen TS et al, 2008

6 Prevalence Increasing prevalence with age 100 Prevalence Reported mean age Prevalence in persons % total Fitted values 95% CI Jensen TS et al, 2008

7 Prevalence Modic changes are common in adult patients with LBP n=4233 Ref: Albert H et al, 2008

8 Development over time

9 Development over time (endplate) Type of Modic changes Persistent LBP, n=1056 (1 year follow-up) Jensen RK et al, 2011

10 Development over time (endplate) Type of Modic changes Persistent LBP, n=1056 (1 year follow-up) 20 % disappeared 40 % changed type 40 % remained the same Jensen RK et al, 2011

11 Development over time (endplate) Type of Modic changes Persistent LBP, n=1056 (1 year follow-up) 20 % disappear 40 % change type 40 % remain the same Size of Modic changes The bigger they are, the more likely they are to persist Jensen RK et al, 2011

12 Association with LBP (cross-sectional)

13 + Number of individuals * Number of levels Study, year Association with LBP Study sample LBP outcome N OR (95 % CI) Braithwaite, 1998 Clinical Discography 152* 9.1 ( ) Ito, 1998 Clinical Discography 101* 11.6 (1.7 - ) Cvitanic, 2000 Clinical Self-reported ( ) Weishaupt, 2001 Clinical Discography 116* 19.9 ( ) Kokkonen, 2002 Clinical Discography 103* 1.1 ( ) Lim, 2005 Clinical Discography 97* 0.5 ( ) Kjaer, 2005 General Self-reported ( ) Schenk, 2006 Working Self-reported 545* 2.0 ( ) Kuisma, 2007 Working Self-reported ( ) Albert, 2007 Clinical Self-reported ( ) O Neill, 2008 Clinical Discography 460* 8.7 (3.0 25) Lei, 2008 Clinical Discography 113* 27.9 ( )

14 + Number of individuals * Number of levels Study, year Association with LBP Study sample LBP outcome N OR (95 % CI) Braithwaite, 1998 Clinical Discography 152* 9.1 ( ) Ito, 1998 Clinical Discography 101* 11.6 (1.7 - ) Cvitanic, 2000 Clinical Self-reported ( ) Weishaupt, 2001 Clinical Discography 116* 19.9 ( ) Kokkonen, 2002 Clinical Discography 103* 1.1 ( ) Lim, 2005 Clinical Discography 97* 0.5 ( ) Kjaer, 2005 General Self-reported ( ) Schenk, 2006 Working Self-reported 545* 2.0 ( ) Kuisma, 2007 Working Self-reported ( ) Albert, 2007 Clinical Self-reported ( ) O Neill, 2008 Clinical Discography 460* 8.7 (3.0 25) Lei, 2008 Clinical Discography 113* 27.9 ( ) Thompson, 2009 Clinical Discography 2457* 2.6 ( ) Chen, 2011 Clinical Discography 256* 14.9 ( ) Hancock, 2012 Case-control Self-reported (1.2 31) Kovacs, 2012 Case-control Self-reported ( ) Takatalo, 2012 General Self-reported ( )

15 + Number of individuals * Number of levels Study, year Association with LBP Study sample LBP outcome N OR (95 % CI) Braithwaite, 1998 Clinical Discography 152* 9.1 ( ) Ito, 1998 Clinical Discography 101* 11.6 (1.7 - ) Cvitanic, 2000 Clinical Self-reported ( ) Weishaupt, 2001 Clinical Discography 116* 19.9 ( ) Kokkonen, 2002 Clinical Discography 103* 1.1 ( ) Lim, 2005 Clinical Discography 97* 0.5 ( ) Kjaer, 2005 General Self-reported ( ) Schenk, 2006 Working Self-reported 545* 2.0 ( ) Kuisma, 2007 Working Self-reported ( ) Albert, 2007 Clinical Self-reported ( ) O Neill, 2008 Clinical Discography 460* 8.7 (3.0 25) Lei, 2008 Clinical Discography 113* 27.9 ( ) Thompson, 2009 Clinical Discography 2457* 2.6 ( ) Chen, 2011 Clinical Discography 256* 14.9 ( ) Hancock, 2012 Case-control Self-reported (1.2 31) Kovacs, 2012 Case-control Self-reported ( ) Takatalo, 2012 General Self-reported ( )

16 Association with LBP (cross-sectional) Update of systematic review from 2008* 17 studies identified Statistically positive association in 12 of 17 studies ORs: Meta-analysis (discography studies only, n=9) Pooled OR: 5.4 ( ) 1 Jensen TS, 2008

17 Association with LBP (longitudinal)

18 Association with LBP (longitudinal) Modic changes Type I No Modic changes Type I Baseline (n=96) 77% (n=74) 23% (n=22) Jensen RK et al, 2011

19 Association with LBP (longitudinal) Modic changes Type I No Modic changes Type I Baseline (n=96) 77% (n=74) 23% (n=22) One year (n=96) 74% (n=55) 26% (n=19) Jensen RK et al, 2011

20 Association with LBP (longitudinal) Modic changes Type I No Modic changes Type I Baseline (n=96) 77% (n=74) 23% (n=22) One year (n=96) 74% (n=55) 26% (n=19) 45% (n=10) 55% (n=12) Jensen RK et al, 2011

21 Association with LBP (longitudinal) Modic changes Type I No Modic changes Type I Baseline (n=96) 77% (n=74) 23% (n=22) One year (n=96) 74% (n=55) 26% (n=19) 45% (n=10) 55% (n=12) Reference Jensen RK et al, 2011

22 Association with LBP (longitudinal) Modic changes Type I No Modic changes Type I Baseline (n=96) 77% (n=74) 23% (n=22) One year (n=96) 74% (n=55) 26% (n=19) 45% (n=10) 55% (n=12) Worsening of LBP intensity OR 9.4 (95% CI ) Reference Jensen RK et al, 2011

23 Association with LBP (longitudinal) Size of Modic changes No association between development of size of Modic changes type I and improvement in LBP

24 Take home messages Prevalence Clinical >> non-clinical Increases with age Development over time Modic changes can disappear or change type Size matters Association with LBP Positive association between Modic changes and LBP Persistent Type I changes = poor prognosis

25 Thank you

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