Viswanathan Vibhu Krishnan, Shetty Ajoy Prasad, Rajasekaran S
Department of Spine Surgery, Ganga Medical Center and Hospitals, Coimbatore, India.
Department of Orthopedics, Ganga Medical Center and Hospitals, Coimbatore, India.
J Clin Orthop Trauma. 2020 Sep-Oct;11(5):761-769. doi: 10.1016/j.jcot.2020.06.025. Epub 2020 Jun 18.
Lumbar degenerative spinal ailments are the most important causes for chronic low back pain. Modic changes (MC) are vertebral bone marrow signal intensity changes seen on MRI, commonly in association with degenerative disc disease (DDD). Despite being widely studied, majority of issues concerning MC are still controversial. The current narrative, evidence-based review comprehensively discusses the various aspects related to MC.
An elaborate search was made using keywords "Modic changes", "lumbar Modic changes", "Modic changes in lumbar spine", and "vertebral Endplate Spinal Changes", on pubmed and google (scholar.google.com) databases on the 3rd of March 2020. We identified crucial questions regarding Modic changes and included relevant articles pertaining to these topics for this narrative review.
The initial search using the keywords "Modic changes", "lumbar Modic changes", "Modic changes in lumbar spine", and "vertebral Endplate Spinal Changes" on pubmed yielded a total of 568, 412, 394 and 216 articles on "pubmed" database, respectively. A similar search using the aforementioned keywords yielded a total of 3650, 3548, 3726 and 21570 articles on "google scholar" database. The initial screening involved exclusion of duplicate articles, articles unrelated to MC, animal or other non-clinical studies, and articles in non-English literature based on abstracts or the titles of articles. This initial screening resulted in the identification of 405 articles. Full manuscripts were obtained for all these selected articles and thoroughly scrutinised at the second stage of article selection. All articles not concerning Modic changes, not pertaining to concerned questions, articles concerning other degenerative phenomena, articles discussing cervical or thoracic MC, case reports or animal studies, articles in non-English language and duplicate articles were excluded. Review articles, randomised controlled trials and level 1 studies were given preference. Overall, 69 articles were included in this review.
Modic change (MC) is a dynamic phenomenon and its true etiology is still not definitely known. Disc/end plate injury, occult discitis and autoimmune reactions seem to trigger an inflammatory cascade, which leads to their development. Male sex, older age, diabetes mellitus, genetic factors, smoking, obesity, spinal deformities, higher occupational loads and DDD are known risk factors. There is no conclusive evidence on the causative role of MC in chronic low back pain (LBP) or any influence on the long term outcome in patients with LBP or lumbar disc herniations (LDH). Patients with MC have been reported to have less satisfactory outcome following conservative treatment or discectomy, although the evidence is still unclear.
腰椎退行性脊柱疾病是慢性下腰痛的最重要原因。Modic改变（MC）是在MRI上可见的椎体骨髓信号强度变化，通常与椎间盘退变疾病（DDD）相关。尽管已得到广泛研究，但有关MC的大多数问题仍存在争议。本叙述性循证综述全面讨论了与MC相关的各个方面。
于2020年3月3日在PubMed和谷歌（scholar.google.com）数据库中，使用关键词“Modic改变”“腰椎Modic改变”“腰椎脊柱的Modic改变”及“椎体终板脊柱改变”进行了详尽检索。我们确定了有关Modic改变的关键问题，并纳入了与这些主题相关的文章以进行本叙述性综述。
在PubMed上，最初使用关键词“Modic改变”“腰椎Modic改变”“腰椎脊柱的Modic改变”及“椎体终板脊柱改变”进行检索，分别在“PubMed”数据库中得到568篇、412篇、394篇和216篇文章。使用上述关键词在“谷歌学术”数据库中进行类似检索，分别得到3650篇、3548篇、3726篇和21570篇文章。初步筛选包括排除重复文章、与MC无关的文章、动物或其他非临床研究以及基于摘要或文章标题的非英文文献中的文章。初步筛选确定了405篇文章。获取了所有这些选定文章的全文，并在文章选择的第二阶段进行了全面审查。排除所有与Modic改变无关、与相关问题无关、涉及其他退变现象、讨论颈椎或胸椎MC、病例报告或动物研究、非英文文章以及重复文章。优先选择综述文章、随机对照试验和一级研究。总体而言，本综述纳入了69篇文章。
Modic改变（MC）是一种动态现象，其真正病因仍不明确。椎间盘/终板损伤、隐匿性椎间盘炎和自身免疫反应似乎引发了炎症级联反应，从而导致其发展。男性、年龄较大、糖尿病、遗传因素、吸烟、肥胖、脊柱畸形、较高的职业负荷和DDD是已知的危险因素。关于MC在慢性下腰痛（LBP）中的致病作用或对LBP或腰椎间盘突出症（LDH）患者长期预后的任何影响，尚无确凿证据。据报道，MC患者在保守治疗或椎间盘切除术后的预后较差，尽管证据仍不明确。
