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Modic Changes Are Not Associated With Long-term Pain and Disability

A Cohort Study With 13-year Follow-up

Udby, Peter Muhareb MD∗,†; Bendix, Tom DmSci; Ohrt-Nissen, Søren MD, PhD; Lassen, Michael Ruud MD; Sørensen, Joan Solgaard MD§; Brorson, Stig MD, PhD; Carreon, Leah Y. MD, MSc; Andersen, Mikkel Østerheden MD

doi: 10.1097/BRS.0000000000003051
CLINICAL CASE SERIES
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Study Design. A comparative cohort study with 13-year follow-up.

Objective. To assess whether Modic changes (MCs) are associated with long-term physical disability, back pain, and sick leave.

Summary of Background Data. Previous studies have shown a conflicting association of low back pain (LBP) with MCs and disc degeneration. The long-term prognosis of patients with MCs is unclear.

Methods. In 2004 to 2005, patients aged 18 to 60 with daily LBP were enrolled in an randomized controlled trial study and lumbar magnetic resonance imaging (MRI) was performed. Patients completed numeric rating scales (0–10) for LBP and leg pain, Roland-Morris Disability Questionnaire (RMDQ), LBP Rating Scale for activity limitations (RS, 0–30), inflammatory pain pattern and sick leave days due to LBP at baseline and 13 years after the MRI. Patients were stratified based on the presence (+MC) or absence (−MC) of MCs on the MRI.

Results. Of 204 cases with baseline MRI, 170 (83%) were available for follow-up; 67 (39%) with MCs and 103 (61%) without MCs. Demographics, smoking status, BMI, use of antibiotics, LBP, leg pain, and inflammatory pain pattern scores at baseline and at 13-year follow-up were similar between the two groups. Also, baseline RMDQ was similar between the +MC and −MC groups. At 13 years, the RMDQ score was statistically significant better in the +MC group (7.4) compared with the −MC group (9.6, P = 0.024). Sick leave days due to LBP were similar at baseline but less in the +MC group (9.0) compared with the −MC group (22.9 d, P = 0.003) at 13 years.

Conclusion. MCs were not found to be negatively associated with long-term pain, disability, or sick leave. Rather, the study found that LBP patients with MCs had significantly less disability and sick-leave at long-term follow-up. We encourage further studies to elucidate these findings.

Level of Evidence: 2

A cohort study of LBP patients with Modic changes. Eighty-three percent of cases (n = 204) are available at 13-year follow-up. MCs were not found to be negatively associated with long-term pain, disability, or sick leave. Rather, the study found that LBP patients with MCs had significantly less disability and sick-leave at long-term follow-up.

Spine Unit, Department of Orthopedic Surgery, Zealand University Hospital, Køge, Denmark

Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

§Department of Radiology, Odense University Hospital, Svendborg, Denmark

Spine Surgery and Research, Spine Center of Southern Denmark – part of Lillebaelt Hospital, Middelfart, Denmark.

Address correspondence and reprint requests to Peter Muhareb Udby, MD, Spine Unit, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark; E-mail: peterudby@gmail.com

Received 7 December, 2018

Revised 11 February, 2019

Accepted 11 March, 2019

The manuscript submitted does not contain information about medical device(s)/drug(s).

The University of Southern Denmark and The Danish Rheumatism Association grant funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, grants, employment, travel/accommodations/meeting expenses.

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