Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan.
Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan.
Spine (Phila Pa 1976). 2022 Mar 15;47(6):490-497. doi: 10.1097/BRS.0000000000004301.
Large-scale, prospective, population-based, longitudinal observational study.
The aim of this study was to investigate the rate of incidence, transformation, and reverse transformation of Modic changes (MCs) using T1-weighted (T1W) and T2-weighted (T2W) lumbar magnetic resonance images (MRI) over a 3-year period.
Although MCs in populational study are considered significant, existing epidemiological evidence is based on cross-sectional studies only.
Overall, 678 subjects (208 men, 470 women, mean age 62.1 ± 12.8 years in 2013) in both 2013 and 2016 surveys were included. The rate of change in Modic Type I (T1W: low-intensity, T2W: high-intensity), Type II (T1W: high, T2W: high), and Type III (T1W: low, T2W: low) at five endplates was analyzed over a 3-year period. An incidence of MC at each level and in the lumbar region was defined as no MC at baseline with signal changes at follow-up. Transformation was defined as Type I or II MC at baseline with conversion at follow-up Type II from Type I or Type III MC from Type I and II. Furthermore, reverse transformation was defined as Type I, II, or III MC at baseline, with at least one endplate showing a reversion in Modic type (no MC for baseline Type I; no MC and Type I for baseline Type II; no MC, Type I or Type II for baseline Type III) at follow-up.
Overall, 3390 endplates were included. For 3 years, the incidence, transformation, and reverse transformation of MCs were seen in 395 (11.7%), 84 (2.5%), and 11 (0.3%) endplates, respectively. The highest levels of incidence, transformation, and reverse transformation were at L2/3 (96 [14.2%] endplates), L5/S1 (32 [4.7%] endplates), and L2/3 (5 [0.7%] endplates), respectively.
This study revealed a high incidence of MCs at the upper lumbar levels and transformation at the lower lumbar levels. Reverse transformation of MCs occurs but are rare.Level of Evidence: 2.
大规模、前瞻性、基于人群的纵向观察研究。
本研究旨在通过 T1 加权（T1W）和 T2 加权（T2W）腰椎磁共振成像（MRI）在 3 年内研究 Modic 变化（MCs）的发生率、转化和逆向转化。
尽管人群研究中的 MC 被认为具有重要意义，但现有的流行病学证据仅基于横断面研究。
总体而言，2013 年和 2016 年调查共纳入 678 名受试者（208 名男性，470 名女性，平均年龄 62.1±12.8 岁）。分析了 5 个终板的 Modic 1 型（T1W：低强度，T2W：高强度）、2 型（T1W：高，T2W：高）和 3 型（T1W：低，T2W：低）的变化率在 3 年内。腰椎区域各水平的 MC 发生率定义为基线时无 MC，随访时信号变化。转化定义为基线时的 I 型或 II 型 MC，随访时转化为 II 型，由 I 型或 III 型 MC 转化而来。此外，逆向转化定义为基线时的 I、II 或 III 型 MC，至少一个终板的 Modic 类型发生逆转（基线 I 型无 MC；基线 II 型无 MC 和 I 型；基线 III 型无 MC、I 型或 II 型）在随访中。
总体而言，共纳入 3390 个终板。3 年内，MC 的发生率、转化和逆向转化分别为 395 个（11.7%）、84 个（2.5%）和 11 个（0.3%）终板。发生率、转化和逆向转化最高的水平分别为 L2/3（96[14.2%]个终板）、L5/S1（32[4.7%]个终板）和 L2/3（5[0.7%]个终板）。
本研究显示，上腰椎水平 MC 的发生率较高，下腰椎水平的转化发生率较高。MC 的逆向转化确实存在，但很少见。
2 级。
