Research Department, Spine Centre of Southern Denmark, Lillebaelt Hospital, Oestre Hougvej 55, 5500 Middelfart, Denmark.
Eur Spine J. 2011 Aug;20(8):1355-62. doi: 10.1007/s00586-011-1794-6. Epub 2011 May 5.
Modic changes are of increasing interest, however their age and gender prevalence are not well described. To date, the associations between Modic changes and other common vertebral pathologies have only been described in small samples (n < 100). Our aim was, in a large dataset of people with low back pain, to (1) describe the prevalence of a range of spinal pathoanatomies, and (2) examine the association between Modic changes and stages of intervertebral disc (IVD) pathology. Common pathologies were coded from the lumbar spine MRIs from 4,233 consecutive people imaged while attending a publicly-funded secondary care outpatient facility in Denmark. Prevalence data were calculated by pathology and by vertebral level. Prevalence was also calculated by age and gender categories for Modic changes. The association between stages of IVD pathology (degeneration, bulge, herniation) and Modic changes at L4/5 and L5/S1 was expressed using prevalence ratios (PR) and 95% confidence intervals. The prevalence of Modic changes and IVD pathology were greater in L4/5 and L5/S1, compared with the upper lumbar spine. There was no significant gender difference in prevalence of Modic changes (p = 0.11). The prevalence of IVD disc pathology occurring concurrently with Modic changes ranged from 11.5 to 17.5% (Type 1), 8.5 to 12.7% (Type 2) and 17.1 to 25.6% (Type 1 and/or 2) while the prevalence occurring in the absence of Modic changes ranged from 0.5 to 6.3% (Type 1), 0.3 to 4.9 (Type 2), 0.8 to 9.7% (Type 1 and/or 2). The associated PR for IVD pathology occurring concurrently with Modic changes ranged from 1.8 to 29.2 (p < 0.05). The highest PR (29.2) was between degeneration and Modic changes, indicating that it is rare for Modic changes to occur without disc degeneration. Spinal pathoanatomy was common in this population, particularly IVD pathologies, and a consistent trend of a relatively greater prevalence in the lower lumbar spine was identified. Modic changes were more likely to be present among individuals with IVD pathology than without, which may implicate mechanical factors as being one aetiological pathway for Modic changes, although other hypotheses may equally explain this association.
目前，Modic 改变与其他常见的脊柱病变之间的关联仅在小样本量（n<100）中进行了描述。我们的目的是在一个患有腰痛的大人群数据集（4233 名连续接受丹麦公共资助的二级保健门诊设施成像的人）中：(1) 描述一系列脊柱病理的患病率；(2) 检查 Modic 改变与椎间盘（IVD）病理阶段之间的关联。常见的病理通过腰椎 MRI 从丹麦一家公共资助的二级保健门诊机构就诊的 4233 名连续患者的腰椎 MRI 中编码。患病率数据根据病理和椎骨水平计算。Modic 改变的患病率也按年龄和性别类别计算。L4/5 和 L5/S1 的 Modic 改变与 IVD 病理阶段（退变、膨出、突出）之间的关联使用患病率比（PR）和 95%置信区间表示。与上腰椎相比，L4/5 和 L5/S1 的 Modic 改变和 IVD 病理的患病率更高。Modic 改变的患病率在性别之间没有显著差异（p=0.11）。同时发生 Modic 改变的 IVD 椎间盘病理的患病率范围为 11.5%至 17.5%（1 型）、8.5%至 12.7%（2 型）和 17.1%至 25.6%（1 型和/或 2 型），而同时发生的患病率在没有 Modic 改变的情况下范围为 0.5%至 6.3%（1 型）、0.3%至 4.9%（2 型）、0.8%至 9.7%（1 型和/或 2 型）。同时发生的 IVD 病理的 PR 范围为 1.8 至 29.2（p<0.05）。最高 PR（29.2）是退变与 Modic 改变之间的 PR，表明 Modic 改变很少在没有椎间盘退变的情况下发生。在该人群中，脊柱病理较为常见，特别是 IVD 病变，并且在较低的腰椎中发现了相对较高的患病率的一致趋势。患有 IVD 病理的个体比没有 IVD 病理的个体更有可能存在 Modic 改变，这可能表明机械因素是 Modic 改变的一个病因途径，尽管其他假说同样可以解释这种关联。
