Mineta Kazuaki, Higashino Kosaku, Sakai Toshinori, Fukui Yoshihiro, Sairyo Koichi
Department of Orthopedics, University of Tokushima, 3-18-15 Kuramoto-cho, 770-8503, Tokushima, Japan.
Skeletal Radiol. 2014 Nov;43(11):1645-9. doi: 10.1007/s00256-014-1947-x. Epub 2014 Jul 9.
Here we report a case of recurrence of Modic type I inflammatory changes in the lumbar spine. A 49-year-old man was referred to our department with a history of chronic low back pain of at least 20 years. At the first consultation, he complained of low back pain only and had no other symptoms such as leg pain, numbness, or weakness. Although his pain was typically mild, he experienced one or two episodes of severe and incapacitating low back pain a year. After two intradiscal steroid injections, his pain disappeared immediately and completely. After 6 months of conservative treatment, Modic type I change switched to Modic type II change. However, 12 months after the first treatment, he once again experienced severe low back pain. Follow-up magnetic resonance imaging (MRI) indicated recurrence of Modic type I change that was stronger than the first occurrence. Two intradiscal injections relieved the pain. Six months after the second episode, follow-up MRI showed another switch of Modic type I change to Modic type II change. Switches of Modic change have been controversial, with mixed findings on pain, natural history, and degenerative changes. The present case reinforces the notion that Modic type I change corresponds to reversible local inflammation.
在此，我们报告一例腰椎Modic I型炎症改变复发的病例。一名49岁男性因至少20年的慢性下腰痛病史转诊至我科。初诊时，他仅主诉下腰痛，无腿痛、麻木或无力等其他症状。尽管他的疼痛通常较轻，但每年会经历一两次严重且使人丧失能力的下腰痛发作。两次椎间盘内注射类固醇后，他的疼痛立即完全消失。经过6个月的保守治疗，Modic I型改变转变为Modic II型改变。然而，首次治疗12个月后，他再次出现严重的下腰痛。随访磁共振成像（MRI）显示Modic I型改变复发，且比首次出现时更严重。两次椎间盘内注射缓解了疼痛。第二次发作6个月后，随访MRI显示Modic I型改变再次转变为Modic II型改变。Modic改变的转变一直存在争议，在疼痛、自然病程和退变改变方面存在不同的研究结果。本病例强化了Modic I型改变对应可逆性局部炎症的观点。
