Braithwaite I, White J, Saifuddin A, Renton P, Taylor B A
Department of Spinal Surgery, The Royal National Orthopaedic Hospital Trust, Stanmore, Middlesex, UK.
Eur Spine J. 1998;7(5):363-8. doi: 10.1007/s005860050091.
The vertebral end-plate has been identified as a possible source of discogenic low back pain. MRI demonstrates end-plate (Modic) changes in 20-50% of patients with low back pain. The aim of this study was to investigate the association between Modic changes on MRI and discogenic back pain on lumbar discography. The MRI studies and discograms of 58 patients with a clinical diagnosis of discogenic back pain were reviewed and the presence of a Modic change was correlated with pain reproduction at 152 disc levels. Twenty-three discs with adjacent Modic changes were injected, 21 of which were associated with pain reproduction. However, pain was also reproduced at 69 levels where no Modic change was seen. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for a Modic change as a marker of a painful disc were 23.3%, 96.8%, 91.3% and 46.5% respectively. Modic changes, therefore, appear to be a relatively specific but insensitive sign of a painful lumbar disc in patients with discogenic low back pain.
椎体终板已被确定为椎间盘源性下腰痛的一个可能来源。MRI显示，20%至50%的下腰痛患者存在终板（Modic）改变。本研究的目的是调查MRI上的Modic改变与腰椎间盘造影时椎间盘源性背痛之间的关联。回顾了58例临床诊断为椎间盘源性背痛患者的MRI研究和椎间盘造影，Modic改变的存在与152个椎间盘水平的疼痛再现相关。对23个伴有相邻Modic改变的椎间盘进行了注射，其中21个与疼痛再现相关。然而，在69个未见Modic改变的水平也出现了疼痛再现。Modic改变作为疼痛性椎间盘标志物的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为23.3%、96.8%、91.3%和46.5%。因此，在椎间盘源性下腰痛患者中，Modic改变似乎是疼痛性腰椎间盘的一个相对特异但不敏感的征象。
