Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 8000, 90014, Oulu, Finland.
Orton Rehabilitation Centre, Tenholantie 10, 00280, Helsinki, Finland.
Sci Rep. 2018 Nov 9;8(1):16630. doi: 10.1038/s41598-018-34933-3.
Modic change (MC) is considered an independent risk factor for low back pain (LBP) but its aetiology remains unclear. In this cross-sectional, large-scale population-based study we sought to characterise associations between endplate defect (ED) and MC in a population sample of broad age range. The study population consisted of 831 twin volunteers (including 4155 discs and 8310 endplates) from TwinsUK. Lumbar T2-weighted MR images were coded for ED and MC. Total endplate (TEP) score was calculated at each intervertebral disc while receiver operating curves (ROC) were calculated to define critical endplate values predictive of MC. MC was detected in 32.1% of the subjects, with a significantly higher prevalence at lower lumbar levels (3.5% at L1/2-L3/4 vs. 15.9% at L4/5-L5/S1, p < 0.001). TEP score was strongly and independently associated with MC at each lumbar level (risk estimates from 1.49 to 2.44; all p ≤ 0.001) after adjustment for age, sex, BMI and twin pairing. ROC analysis showed a TEP score cut-off of 6 above which there was a significantly higher prevalence of MC. In conclusion, ED were strongly associated with MC at every lumbar level. These findings support the hypothesis that endplate defect is a major initiating factor for the cascade of events that may include disc degeneration (DD) and MC.
Modic 改变（MC）被认为是腰痛（LBP）的独立危险因素，但病因仍不清楚。在这项横断面、大规模的基于人群的研究中，我们试图在广泛年龄范围内的人群样本中描述终板缺陷（ED）与 MC 之间的关联。研究人群包括来自 TwinsUK 的 831 对双胞胎志愿者（包括 4155 个椎间盘和 8310 个终板）。腰椎 T2 加权磁共振图像对 ED 和 MC 进行编码。在每个椎间盘计算总终板（TEP）评分，同时计算接收者操作曲线（ROC）以定义预测 MC 的临界终板值。在 32.1%的受试者中检测到 MC，在较低的腰椎水平（L1/2-L3/4 为 3.5%，L4/5-L5/S1 为 15.9%，p<0.001）的患病率明显更高。TEP 评分与每个腰椎水平的 MC 显著相关（风险估计值为 1.49 至 2.44；所有 p≤0.001），调整年龄、性别、BMI 和双胞胎配对后。ROC 分析显示 TEP 评分高于 6 的截点，MC 的患病率明显更高。总之，ED 与每个腰椎水平的 MC 密切相关。这些发现支持终板缺陷是可能包括椎间盘退变（DD）和 MC 的一系列事件的主要起始因素的假说。
