Applebaum Ariella, Nessim Adam, Cho Woojin
Department of Orthopedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
Clin Spine Surg. 2022 Feb 1;35(1):12-17. doi: 10.1097/BSD.0000000000001168.
This was a literature review.
The objective of this study was to review the pathogenesis, prevalence, clinical associations, diagnostic modalities, and treatment options for patients with lower back pain (LBP) associated with Modic change (MC).
Vertebral body endplates are located between the intervertebral disk and adjacent vertebral body. Despite their crucial roles in nutrition and biomechanical stability, vertebral endplates are extremely susceptible to mechanical failure. Studies examining the events leading to disk degeneration have shown that failure often begins at the endplates. Endplate degeneration with subchondral bone marrow changes were originally noticed on magnetic resonance imaging. These magnetic resonance imaging signal changes were classified as MC.
A literature review was conducted on the history, etiology, risk factors, diagnostic modalities, and treatment of LBP with MC.
Type 1 MC refers to the presence of increased vascularization and bone marrow edema within the vertebral body. Type 2 MC involves fatty marrow replacement within the vertebral body. Type 3 MC reflects subchondral bone sclerosis. Despite the original classification, research has supported the notion that MCs possess a transitional nature. Furthermore, type 1 MCs have been strongly associated with inflammation and severe LBP, while types 2 and 3 tend to be more stable and demonstrate less refractory pain. With a strong association to LBP, understanding the etiology of MC is crucial to optimal treatment planning. Various etiologic theories have been proposed including autoimmunity, mechanics, infection, and genetic factors.
With the aging nature of the population, MC has emerged as an extremely prevalent issue. Research into the pathogenesis of MC is important for planning preventative and therapeutic strategies. Such strategies may include rehabilitation, surgical fixation, stabilization, steroid or cement injection, or antibiotics. Improved diagnostic methods in clinical practice are thus critical to properly identify patients suffering from MC, plan early intervention, and hasten return to functioning.
这是一项文献综述。
本研究的目的是回顾与Modic改变（MC）相关的下腰痛（LBP）患者的发病机制、患病率、临床关联、诊断方法和治疗选择。
椎体终板位于椎间盘和相邻椎体之间。尽管它们在营养和生物力学稳定性方面起着关键作用，但椎体终板极易发生机械性破坏。研究导致椎间盘退变的事件表明，破坏通常始于终板。终板退变伴软骨下骨髓改变最初在磁共振成像上被发现。这些磁共振成像信号改变被归类为MC。
对伴有MC的LBP的病史、病因、危险因素、诊断方法和治疗进行了文献综述。
1型MC是指椎体内血管增多和骨髓水肿。2型MC涉及椎体内脂肪骨髓替代。3型MC反映软骨下骨硬化。尽管有最初的分类，但研究支持MC具有过渡性质的观点。此外，1型MC与炎症和严重LBP密切相关，而2型和3型往往更稳定，顽固性疼痛较少。由于与LBP密切相关，了解MC的病因对于优化治疗计划至关重要。已经提出了各种病因理论，包括自身免疫、力学、感染和遗传因素。
随着人口老龄化，MC已成为一个极其普遍的问题。对MC发病机制的研究对于制定预防和治疗策略很重要。此类策略可能包括康复、手术固定、稳定化、类固醇或骨水泥注射或抗生素。因此，临床实践中改进的诊断方法对于正确识别患有MC的患者、规划早期干预并加速恢复功能至关重要。
