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MICROSTRUCTURE AND REMODELLING IN MODIC CHANGES: 13.

Osti, O. L.; Zahari, Shahrid; Ooi, John TC; Truong, Lean; Perilli, Egon; Fazzalari, Nicola L.

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Spine Journal Meeting Abstracts: October 2010 - Volume - Issue - p 13
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INTRODUCTION: To determine bone microstructure and remodelling of lumbar vertebrae with Modic changes in individuals undergoing spinal surgery.

METHOD: Twenty one patients with Modic changes on MRI undergoing surgery with pedicular screws had a transpedicular end plate biopsy taken. A micro‐CT scan of the biopsy was carried out for a 3D analysis and Von Kossa and H&E 5‐um sections were prepared for tissue‐level bone remodelling analysis.

RESULTS: All 21 biopsies underwent micro‐CT and tissue‐level analyses. The average bone volume (BV/TV [%]) was 15.1% for Modic 1 specimens, 16.4% for Modic 2 and 26.6% for Modic 3. The bone volume increase was associated with bone trabecular thickening and increased trabecular number. Structure model index (SMI) values suggested that Modic 3 (SMI = 0.2) samples were more plate like compared with Modic 1 and Modic 2 (SMI = 1.0 both). Tissue‐level analysis showed less eroded surface in Modic 3 (4.7%) compared with Modic 1 and 2 (7.5% and 7.7% respectively). There was also more osteoid but reduced resorption surface in Modic 3 (4.5%) compared with Modic 2 (2.5%) and Modic 1 (2.2%).

DISCUSSION: This study has shown micro‐architectural differences between Modic types. It can be postulated that different Modic types represent different stages of the same pathological process. Modic 3 changes are consistent with a more stable sclerotic phase associated with higher BV/TV due to reduced resorption and more osteoid. Modic 1 changes are the least stable phase with lowest bone volume and osteoid surface.

© 2010 Lippincott Williams & Wilkins, Inc.