A Prospective, 3-year Longitudinal Study of Modic Changes of the Lumbar Spine in a Population-based Cohort: The Wakayama Spine Study

• Published in: Spine (Philadelphia, Pa. 1976) Vol. 47; no. 6; p. 490
• Main Authors: Tamai, Hidenobu, Teraguchi, Masatoshi, Hashizume, Hiroshi, Oka, Hiroyuki, Cheung, Jason P Y, Samartzis, Dino, Muraki, Shigeyuki, Akune, Toru, Kawaguchi, Hiroshi, Nakamura, Kozo, Tanaka, Sakae, Yoshida, Munehito, Yoshimura, Noriko, Yamada, Hiroshi
• Format: Journal Article
• Language: English
• Published: United States 15.03.2022
• Subjects: Aged; Cross-Sectional Studies; Female; Humans; Intervertebral Disc Degeneration - pathology; Longitudinal Studies; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - pathology; Lumbosacral Region - diagnostic imaging; Lumbosacral Region - pathology; Magnetic Resonance Imaging - methods; Male; Middle Aged; Prospective Studies
• ISSN: 1528-1159
• DOI: 10.1097/BRS.0000000000004301

Large-scale, prospective, population-based, longitudinal observational study. 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. Although MCs in populational study are considered significant, existing epidemiological evidence is based on cross-sectional studies only. 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. 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. 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.