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Modic changes

Modic changes are (MRI) findings characterized by alterations in signal intensity within the vertebral and adjacent endplates, typically observed in the spine and associated with . These changes were first systematically classified by Michael T. Modic and colleagues in 1988 based on their distinct MRI patterns, reflecting underlying pathological processes such as inflammation, fatty replacement, or sclerosis in the subchondral bone. They are categorized into three main types: Type 1, which appears hypointense on T1-weighted images and hyperintense on T2-weighted images, indicating and inflammatory changes; Type 2, which shows hyperintensity on both T1- and T2-weighted images due to fatty marrow infiltration; and Type 3, which is hypointense on both sequences, suggestive of subchondral bone sclerosis. Mixed types, representing transitional states, are also recognized. Clinically, Modic changes are prevalent in 8–80% of individuals with chronic , compared to 0.5–47% in populations, with Type 1 changes most strongly correlated with severity, functional disability, and reduced . Their involves mechanical damage to the vertebral endplate from degeneration, leading to release (e.g., TNF-α, IL-1β), , and ingrowth into the , which may contribute to vertebrogenic ; changes can progress from Type 1 to Type 2 but may also regress in some cases. Risk factors include advanced age, , , and genetic predispositions, while they are often dynamic. Although not all Modic changes cause symptoms and their causal role in remains debated, they serve as important biomarkers for identifying patients suitable for targeted interventions, such as basivertebral , which has shown sustained relief in clinical trials as of 2025.

Definition and Classification

Definition

Modic changes refer to pathological alterations in the vertebral endplates and adjacent , characterized by signal intensity variations observable on (MRI). These changes primarily occur in the lumbar and are closely linked to the degenerative processes affecting the . First described by Michael Modic and colleagues in , these alterations were identified through MRI examinations of patients with , highlighting their association with structural changes in the vertebral bodies adjacent to degenerated intervertebral discs. The original observations emphasized how such marrow modifications reflect a spectrum of responses to ongoing disc pathology. Modic changes are strongly associated with degeneration (DDD) and serve as a key clinical marker for chronic (LBP), appearing more frequently in symptomatic individuals than in asymptomatic controls. Rather than static anomalies, they function as dynamic markers of the age-related degenerative cascade in the , potentially evolving over time in response to biomechanical and biological factors.

Types of Modic Changes

Modic changes are classified into three primary types based on their magnetic resonance imaging (MRI) signal characteristics in the vertebral endplates and adjacent bone marrow, reflecting distinct histopathological processes. Type 1 changes, indicative of an inflammatory and edema-like state, appear hypointense on T1-weighted MRI and hyperintense on T2-weighted MRI. Histopathologically, Type 1 lesions feature vascularized granulation tissue, fissuring of the endplate, inflammation, and increased bone turnover. Type 2 changes represent fatty marrow replacement and are characterized by hyperintense signals on both T1-weighted and T2-weighted (or isointense on T2) MRI sequences. These correspond to histopathological findings of fatty degeneration of the , often with persistent endplate disruption and fibrovascular tissue. Type 3 changes denote a sclerotic phase, showing hypointense signals on both T1-weighted and T2-weighted MRI. Histologically, they involve bone sclerosis with reduced cellularity and stable, low bone formation activity. Modic changes can present as mixed types, such as Type 1/2 or Type 2/3, occurring in approximately 20% of cases, and are interconvertible over time, with Type 1 often progressing to Type 2 within 1-2 years. Type 1 changes are most strongly associated with .
TypeMRI T1 SignalMRI T2 SignalHistopathological Features
1HypointenseHyperintenseVascularization, fissuring,
2HyperintenseIso/hyperintenseFatty degeneration
3HypointenseHypointenseBone sclerosis
The absence of Modic changes is sometimes designated as Type 0, representing the normal baseline appearance of vertebral without signal abnormalities, which aids in comparative assessments.

Mechanical and Degenerative Mechanisms

Modic changes are closely linked to degeneration, where progressive breakdown of the disc's exposes the vertebral endplates to increased mechanical stress, leading to damage and subsequent . degeneration reduces the disc's ability to absorb and distribute loads, concentrating forces on the thin endplates (approximately 0.6 mm thick), which results in structural weakening and the characteristic signal changes observed in Modic type 1 lesions. This process is exacerbated in the lumbar spine, particularly at levels L4-S1, where biomechanical demands are highest due to the region's role in and . Mechanical factors play a central role in endplate , with repeated forces and axial inducing microfractures that disrupt the endplate's integrity and allow fluid ingress into the space. Studies demonstrate that applying 50–80% of the endplate's for as few as 100 cycles can cause such microfractures, altering load distribution and promoting uneven stress transfer between the and . In the region, torsional and compressive loads from daily activities further contribute to this damage, with endplate defects graded as moderate to severe (score ≥4) strongly predicting the onset of Modic changes across age groups. These changes are intrinsically tied to age-related degenerative processes, as the prevalence of Modic lesions rises progressively with advancing , reflecting cumulative on spinal structures. Loss of disc height, a hallmark of degeneration, correlates directly with Modic severity, reducing segmental and amplifying that perpetuates further endplate . Biomechanical studies, including animal models of chronic axial loading, confirm this association, showing that simulated spinal loading induces marrow alterations similar to Modic type 1 changes. Additionally, data link heavy occupational loading to higher Modic incidence, with ratios exceeding 11 for individuals in physically demanding roles, underscoring the impact of altered spinal mechanics.

Infectious Hypotheses

The infectious hypothesis posits that Modic changes, particularly type 1, may arise from low-virulence bacterial infections that infiltrate the intervertebral disc and vertebral endplate, triggering chronic inflammation. This theory suggests that mechanical disruption of the disc, such as during herniation, creates pathways for bacterial entry from adjacent tissues or hematogenous spread, leading to localized infection and the characteristic bone marrow edema seen on MRI. Proponents argue that this process explains the inflammatory nature of type 1 changes, distinguishing it from purely degenerative mechanisms. Cutibacterium acnes (formerly Propionibacterium acnes), a commensal bacterium, has been prominently implicated in this , particularly in postoperative or post-herniation contexts. Studies indicate that C. acnes can colonize disc herniation surgery sites, persisting in biofilms and releasing pro-inflammatory metabolites that sustain vertebral endplate . For instance, in patients with lumbar disc herniation and adjacent Modic changes, C. acnes has been isolated from extruded disc material, correlating with the presence and severity of type 1 lesions. Evidence supporting bacterial involvement includes microbiological culturing from and endplate tissues. Multiple studies have reported positive cultures of C. acnes and other low-virulence in up to 46% of samples from patients with Modic changes, compared to significantly lower rates in controls without changes. These findings are drawn from intraoperative biopsies during spinal surgery, where culturing techniques revealed in vertebral adjacent to affected endplates. Recent advances in 2025 have bolstered molecular detection methods, confirming bacterial DNA presence in endplate biopsies. A study employing 2bRAD-M sequencing on Modic change samples identified enriched microbial communities, including Escherichia coli DNA in 60% of cases, suggesting an infective contribution to pathogenesis beyond culturing limitations. These techniques, which provide species-level resolution without relying on viable bacteria, have detected diverse low-virulence pathogens in endplate tissues, supporting the hypothesis of subclinical infection. The causality of this infectious link remains debated, with concerns over contamination during sampling versus true pathogenic invasion. While correlative evidence is strong, randomized trials yield mixed results: a double-blind study reported significant reduction with 100-day therapy in patients with type 1 changes, but a larger trial found no clinically meaningful benefit from amoxicillin over at one-year follow-up. A 2023 meta-analysis of such trials indicated low-quality evidence for modest improvements in and with , highlighting the need for further validation. This controversy has implications for targeted therapies in select cases.

Inflammatory and Other Processes

Modic changes, particularly type 1, have been implicated in autoimmune responses within the vertebral endplate, where disruption of the endplate integrity exposes nuclear material to the , triggering a sterile inflammatory cascade. This process involves the activation of innate immune cells, such as monocytes and macrophages, which polarize toward pro-inflammatory phenotypes, releasing that sustain tissue damage and . Key mediators include tumor factor-alpha (TNF-α), which promotes the expression of matrix metalloproteinases and further production, and interleukin-6 (IL-6), which amplifies the inflammatory response by stimulating acute-phase proteins and recruiting additional immune cells to the endplate region. Genetic predispositions play a role in susceptibility to Modic changes, with twin studies indicating heritability estimates around 30-40% for their development in the lumbar spine. Genome-wide association studies have identified specific loci, such as on , linked to Modic changes, suggesting polygenic influences on endplate and remodeling. Although direct links to (HLA) genes remain under investigation, Metabolic factors contribute to inflammatory processes in Modic changes through dysregulation and . In , expanded vertebral marrow releases pro-inflammatory like and , which exacerbate endplate and correlate with the severity of Modic lesions by promoting activity and release. Smoking induces via , leading to nitrosative damage in endplate cells, heightened , and elevated biomarkers of oxidative/nitrosative stress in patients with Modic changes, thereby accelerating inflammatory degeneration. These inflammatory pathways often intersect with degenerative processes, suggesting mixed etiologies where initial mechanical stress on the endplate initiates release, which in turn drives progressive and alterations characteristic of Modic changes. This interplay underscores the multifactorial nature of the condition, with amplifying degenerative changes through sustained immune activation and metabolic perturbations.

Clinical Features

Associated Symptoms

Modic changes are primarily associated with chronic (LBP), defined as pain lasting more than three months. This association is particularly strong in patients undergoing MRI for persistent symptoms, where Modic changes appear in 18-58% of chronic LBP cases compared to 12-13% in populations. Beyond pain, individuals with Modic changes often experience non-pain symptoms such as reduced mobility and activity limitations, which may stem from associated vertebral endplate disruptions and degenerative processes. Occasional radicular symptoms, including leg pain or numbness, can occur when Modic changes coincide with disc herniation or involvement. Symptom activity correlates strongly with the type of Modic change: Type 1 changes, characterized by , are linked to more active and pronounced clinical manifestations, while Types 2 and 3 are frequently or associated with milder effects. Type 1 changes exhibit higher odds of pain and functional impairment compared to Type 2 ( 1.97). These symptoms contribute to significant impacts on , with patients showing elevated disability scores on the Oswestry Disability Index (), particularly in severe or Type 1 cases, reflecting limitations in daily activities and overall health-related . Higher scores are noted in individuals with extensive Modic lesions, underscoring their role in long-term .

Pain Characteristics

Modic changes, particularly type 1, are strongly associated with chronic, localized low back pain that exhibits an inflammatory character, including features such as morning stiffness lasting more than 30 minutes and improvement with exercise but worsening with rest. Patients with type 1 Modic changes report pain that peaks in the morning and often disrupts sleep, with approximately 81% experiencing nighttime awakenings due to back pain after at least four hours of sleep. This inflammatory pain pattern is defined clinically as involving nocturnal exacerbation and prolonged morning stiffness, distinguishing it from mechanical low back pain profiles. Pain provocation in Modic changes frequently occurs with lumbar extension or axial loading, as evidenced by prospective studies showing a significant association between type 1 changes and pain elicited during these maneuvers. For instance, upright positioning, which imposes biomechanical loading, correlates with increased area of type 1 Modic lesions on MRI and heightened pain intensity, with a Spearman's rho of 0.34 indicating a moderate positive relationship. This suggests that mechanical stress exacerbates the underlying endplate and marrow inflammation, contributing to the localized nature of the discomfort centered around the affected vertebral levels. Quantitative assessments reveal elevated intensity in patients with Modic changes compared to those without, with type 1 lesions linked to a of 1.1 (95% 0.4 to 1.7; p=0.001) for maximum on standardized scales. Visual analog scale (VAS) scores for are notably higher in individuals with type 1 or mixed type 1/2 Modic changes, often exceeding those in non-Modic cohorts by clinically meaningful margins. Furthermore, this demonstrates relative unresponsiveness to standard analgesics, including non-steroidal anti-inflammatory drugs and initial steps of the WHO ladder, affecting over 80% of affected patients. Recent 2025 evidence from cross-sectional analyses confirms distinct pain profiles in Modic versus non-Modic cohorts, with type 1 changes conferring higher odds of chronicity (OR 7.3, 95% 3.1–17.0; p<0.001) and greater overall disability alongside intensified pain. These profiles are characterized by more frequent medical consultations and prolonged episodes, underscoring the inflammatory and persistent quality unique to Modic-associated pain.

Epidemiology

Prevalence

Modic changes are identified on magnetic resonance imaging (MRI) in approximately 6% of asymptomatic individuals in the general population, with prevalence rates ranging from 4% to 13% across studies. In contrast, among patients with chronic (), the prevalence is substantially higher, with a median of 43% reported in systematic reviews encompassing non-specific LBP and sciatica cases. Recent 2025 epidemiological data from large population-based cohorts in industrialized regions confirm elevated rates, reaching up to 35% in adults undergoing lumbar spine imaging, reflecting increased detection with advancing degenerative processes. Prevalence of Modic changes increases progressively with age, remaining low in the second decade of life but rising notably from the 20s onward, often peaking in the 50s to 60s before stabilizing. These changes predominantly affect the lumbar spine, with over 70-80% occurring at the lower levels, particularly L4-L5 and L5-S1, where biomechanical stress is greatest. This segmental distribution aligns with patterns of disc degeneration, though Modic changes can appear independently. Type-specific prevalence varies by population and study, but Type 2 changes (fatty marrow replacement) are the most common overall, observed in 16-50% of cases, particularly in older or asymptomatic individuals. Type 1 changes (inflammatory/edematous) are less frequent in the general population (around 4%) but increase to 10-23% in chronic LBP patients, often correlating with acute symptoms. Type 3 changes (sclerotic) are rare across all groups, comprising less than 1-5% of cases.

Risk Factors

Modic changes are more prevalent in individuals over the age of 40, with risk increasing progressively with advancing age due to cumulative degenerative processes in the spine. A 2025 meta-analysis confirms significant associations with disc degeneration (OR=8.54), endplate changes (OR=3.56), spondylolisthesis (OR=2.00), physical labor (OR=1.81), and reduced lumbar lordosis angle. Sex differences in prevalence are inconsistent across studies; while some report higher rates in women (e.g., 27.9% vs. 16.2% in men), a 2025 meta-analysis found no significant association. Occupational exposure to heavy lifting and physically demanding work further elevates the risk, as self-reported hard physical labor has been associated with the development of these vertebral changes, particularly in the lumbar region. Some studies associate smoking with increased risk (e.g., OR=4.09 in chronic low back pain patients), potentially through impaired vascular supply to the vertebral endplates, but a 2025 meta-analysis found no significant overall association (OR=1.15). Higher body mass index (BMI >30) has been linked in some studies to greater , possibly due to increased mechanical loading on the , but a 2025 found no significant association (OR=1.07). Sedentary behavior, characterized by prolonged sitting and low levels, has also been implicated, as it may exacerbate disc nutrition deficits and endplate in susceptible individuals. The association with prior lumbar disc herniation is debated; while some studies report markedly higher incidence post-herniation, especially types 1 and 2 in the following year, a 2025 meta-analysis found no significant link. Spinal trauma represents another key risk, as injury to the vertebral endplate can trigger inflammatory and degenerative responses leading to these MRI findings. Genetic predispositions, including family history of degenerative disc disease, contribute to susceptibility, with specific polymorphisms influencing endplate integrity and marrow alterations. Recent research as of 2025 has highlighted endocrine connections, particularly , as an emerging , with elevated HbA1c levels and longer diabetes duration associated with increased Modic change prevalence through mechanisms like glycemic-induced endplate damage. Socioeconomic disparities also play a role, as lower correlates with higher exposure to modifiable risks like and , thereby amplifying overall vulnerability in affected populations.

Diagnosis

Imaging Characteristics

Magnetic resonance imaging (MRI) serves as the gold standard for detecting and characterizing Modic changes, which manifest as signal intensity alterations in the subchondral adjacent to vertebral endplates. These changes are best visualized on sagittal T1-weighted and T2-weighted sequences, where they appear contiguous to degenerated intervertebral discs. The classification into types 1, 2, and 3 relies on distinct signal patterns that reflect underlying histopathological processes, such as , fatty infiltration, or sclerosis. Type 1 Modic changes are characterized by hypointensity on T1-weighted images and on T2-weighted images, corresponding to and . Type 2 changes demonstrate on both T1- and T2-weighted sequences, indicative of fatty marrow replacement. Type 3 changes appear hypointense on both T1- and T2-weighted images, representing subchondral bone sclerosis. Computed tomography (CT) plays a supportive role, particularly for type 3 changes, where it confirms endplate sclerosis through increased bone density, though it lacks sensitivity for types 1 and 2. Conventional radiography (X-ray) has significant limitations, detecting only advanced sclerotic alterations in type 3 changes while missing earlier marrow signal variations. Advances in imaging as of 2025 include quantitative MRI techniques, such as T2 mapping, which provide objective measures of tissue composition for assessing Modic change severity, and diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) quantification to enhance early detection and differentiation from infectious processes.

Differential Diagnosis

Modic changes, particularly type 1, must be differentiated from infectious processes such as vertebral or , which can present with similar MRI signal alterations in the vertebral endplates. Unlike Modic changes, vertebral osteomyelitis typically involves disc space narrowing and abnormal disc signal intensity on T2-weighted MRI, along with systemic signs like fever and elevated (CRP) levels. Clinical history plays a crucial role, as Modic changes are often linked to chronic without acute infectious symptoms, whereas osteomyelitis may show or positive blood cultures. Laboratory tests further aid differentiation; for instance, elevated (ESR) or CRP can suggest or but are nonspecific, necessitating correlation with and history to rule out Modic changes. Follow-up MRI, including diffusion-weighted sequences, can reveal the "claw sign" in Modic type 1 changes—peripheral diffusion restriction mimicking abscesses—but its absence or presence helps distinguish degenerative from pyogenic involvement. If ambiguity persists, may be required to confirm degeneration versus , as Modic changes lack microbiological evidence. Vertebral fractures represent another mimic, especially acute compression fractures that induce bone marrow edema resembling Modic type 1 signals on MRI. Distinction relies on a history of or risk factors, which are absent in typical Modic changes associated with insidious disc degeneration. Metastatic can also imitate Modic changes through lytic or blastic lesions causing marrow signal alterations, often at multiple levels. Key differentiators include systemic symptoms such as or known primary malignancy, contrasted with the localized, endplate-focused nature of Modic changes without widespread skeletal involvement. Rare overlaps occur with conditions like , where chronic inflammation may produce endplate erosions and Modic-like signals, but and syndesmophytes on imaging, plus elevated positivity, favor the former. Similarly, Paget's disease can mimic through coarsened trabeculae and changes, distinguished by and characteristic expansion on radiographs.

Treatment

Conservative Approaches

Conservative approaches to managing Modic changes focus on non-invasive strategies to alleviate associated , emphasizing and symptom control as first-line interventions. , including core stabilization and aerobic programs, is commonly recommended for patients with Modic changes, though indicates limited , particularly for type 1 changes. A comparing 10 weeks of supervised exercise (focusing on stabilizing muscles and aerobic conditioning) to rest in 100 patients with persistent and Modic changes found no significant differences in reduction, disability, or outcomes at 10 weeks or 1 year, suggesting both approaches are equally ineffective for this subgroup. Despite this, graded exercise remains a of conservative care to promote overall and prevent progression. Physical modalities such as heat or ice application and are often employed adjunctively, but they show limited standalone effectiveness in Modic patients. These interventions aim to reduce and improve mobility, yet studies on conservative treatments for degenerative disc-related , including Modic changes, report poorer outcomes compared to non-Modic cases, with alone failing to address underlying alterations. Lifestyle modifications play a supportive role in mitigating risk factors and symptoms. is advised to lessen vertebral endplate stress, as excess body weight exacerbates Modic-associated pain; even modest reductions can improve outcomes in vertebrogenic . Ergonomic adjustments, such as optimizing workstation setups to reduce heavy lifting and prolonged sitting, help minimize occupational loads that contribute to Modic progression. is particularly relevant, given its association with increased Modic change prevalence ( 4.09); quitting reduces this risk and supports better conservative treatment responses. As of 2025, guidelines from orthopedic societies recommend multidisciplinary rehabilitation programs integrating exercise, education, and lifestyle counseling for symptom control in Modic-related low back pain, positioning these as initial management before considering advanced options.

Antibiotic and Pharmacological Therapies

Antibiotic therapies for Modic changes primarily target the infectious hypothesis, which posits that low-grade bacterial infections, such as those involving Propionibacterium acnes or other microbes, contribute to the inflammatory vertebral endplate changes observed in types 1 and 2. Prolonged antibiotic regimens have been investigated in randomized controlled trials (RCTs) from 2019 to 2025, focusing on patients with chronic low back pain (LBP) and Modic changes adjacent to prior disc herniations. The seminal AIM study (2019) evaluated a 100-day course of oral amoxicillin-clavulanate (750 mg three times daily) versus placebo in 180 patients, reporting a statistically significant reduction in LBP intensity (mean difference -1.6 on a 0-10 numerical rating scale at 12 months) and disability, with greater benefits in those with type 1 changes, though the clinical effect size was small and below the minimal clinically important difference threshold of 2-3 points. A 2023 systematic review and meta-analysis of available RCTs found low-quality evidence for short-term pain reduction (mean difference -1.14 at 100 days) but no significant long-term pain relief at 12 months (mean difference -1.53, 95% CI -3.20 to 0.13), alongside moderate-quality evidence for disability improvement (mean difference -3.71 at 12 months). Ongoing 2025 trials continue to test amoxicillin regimens specifically for type 1 Modic changes, emphasizing patient selection based on MRI findings. Evidence from these trials indicates partial pain relief in subsets of patients, particularly those with type 1 changes and evidence of prior disc surgery, but overall benefits are inconsistent across studies, with some showing no superiority over . Risks include antibiotic resistance, with concerns raised about promoting multidrug-resistant strains through extended use, as well as common adverse effects like and affecting up to 20% of treated individuals. Recent 2025 metagenomic analyses of disc tissues have identified microbial in Modic change samples, with enrichment of pathogens like , supporting the potential for biopsy-guided targeted antibiotics to improve outcomes by addressing specific bacterial profiles rather than broad-spectrum regimens. Pharmacological anti-inflammatory treatments aim to mitigate the and characteristic of type 1 Modic changes. Non-steroidal drugs (NSAIDs), such as celecoxib, are commonly prescribed as first-line , often in stepped-care protocols where a 2-week course (200 mg twice daily) provides initial pain relief in approximately 64% of patients with Modic types 1 or 2. These agents reduce prostaglandin-mediated at the endplate, offering short-term symptomatic , though long-term efficacy for Modic-specific pain remains limited by tolerance issues and gastrointestinal risks. Biologics targeting tumor necrosis factor-alpha (TNF-α), such as infliximab, have been explored for type 1 Modic changes due to their role in suppressing inflammatory cytokines. A 2024 double-blind RCT of 128 patients administered intravenous infliximab (5 mg/kg at weeks 0, 2, 6) versus placebo, finding no significant difference in disability reduction (Oswestry Disability Index change: -7.0 vs. -6.4 points at 5 months) or pain intensity. Earlier protocols similarly investigated infliximab but yielded inconclusive results, with higher rates of moderate adverse events like infections (22% vs. 13% in placebo). Overall, biologics show no established benefit for Modic-related LBP and are not routinely recommended due to cost, infusion-related risks, and lack of targeted evidence.

Surgical Options

Surgical interventions for Modic changes are generally reserved for cases where has failed and there are concurrent structural abnormalities, such as severe spinal instability or disc herniation, rather than targeting the Modic changes in isolation. Common procedures include for herniated discs associated with Modic changes and to address instability, particularly in patients with disc herniation or . Clinical outcomes following these surgeries show limited direct benefit attributable to the presence of Modic changes alone, with most studies indicating no significant impact on pain relief or functional improvement from procedures like , , or disc replacement. However, patients with higher-grade Modic changes, such as those classified as MCG-B (25-50% involvement) or MCG-C (>50%), often experience inferior patient-reported outcomes, including higher VAS-back scores and at two-year follow-up after surgery. Type 1 Modic changes are associated with higher complication rates, including an increased risk of postoperative pyogenic and surgical site infections following or procedures.

Interventional Procedures

Basivertebral ablation (BVNA) is a targeting the basivertebral within the vertebral body to alleviate vertebrogenic associated with Modic changes, particularly types 1 and 2. It is indicated for patients with chronic and MRI evidence of Modic changes without . Recent randomized controlled trials, including the SMART trial (2021) and follow-up data through 2025, have demonstrated significant and sustained improvements in (VAS reduction of ~3-4 points) and function (ODI improvement of ~20-25 points) at 24 months compared to procedures, with responder rates >70% for ≥50% relief. The procedure involves under fluoroscopic guidance and has a favorable safety profile, with low rates (<5%) of device- or procedure-related adverse events. As of 2025, BVNA is increasingly recommended for appropriately selected patients as an alternative to more invasive . Minimally invasive techniques, such as full-endoscopic intra-discal and disc cleaning, have been employed particularly for suspected infected cases involving type 1 Modic changes, where low-virulence bacterial involvement is hypothesized. In a case series of patients with chronic due to Modic changes, this approach led to significant VAS pain reduction from 6.3 to 3.1 at final follow-up, with no reported intraoperative or postoperative complications, though two patients required revision . Endoscopic combined with metagenomic sequencing has also shown in managing primary spinal infections mimicking Modic changes, facilitating targeted drainage without extensive open . Recent 2025 evidence from surgery cohorts reinforces that Modic changes do not consistently reverse postoperatively, with persistence observed regardless of procedure type, and major changes correlating with poorer long-term recovery in surgeries. For instance, in cases, preoperative Modic change grading predicted suboptimal outcomes without evidence of endplate signal normalization on follow-up MRI. Type 2 changes, in particular, were linked to inferior ten-year outcomes after , highlighting the prognostic role of Modic typology in surgical planning.

Prognosis

Natural History

Modic changes demonstrate a dynamic on (MRI), with type 1 changes, characterized by and , frequently progressing to type 2 changes, indicative of fatty marrow replacement. In a of 48 type 1 lesions followed for 12 to 72 months, 37.5% fully converted to type 2, and an additional 14.6% showed partial conversion, while 39.6% worsened in extent and 8.3% remained unchanged, with no cases regressing to normal marrow signal. Similarly, in a community-based of 56 adults assessed over approximately 2 years, 4 of 6 baseline type 1 lesions persisted as type 1, and 2 progressed to type 2, underscoring the typical transitional pathway without spontaneous resolution. Regression of Modic changes is uncommon, and complete spontaneous disappearance is rare. A prospective 3-year population-based study of 3,390 lumbar endplates found reverse transformation (e.g., type 2 to type 1) in only 0.3% of cases, with reverse transformations, including to normal marrow, occurring in 0.3% of cases. Type 2 changes, once established, exhibit high persistence, remaining stable in 18 of 22 cases over 2 to 3 years in one cohort, with limited reversion. Overall, these changes do not spontaneously resolve but tend to stabilize with advancing age, as their prevalence correlates positively with age and cumulative degenerative load in the spine. The progression of Modic changes is influenced primarily by ongoing degeneration in untreated individuals. Reduced disc height at baseline more than doubled the odds of incident type 2 changes ( 1.9, 95% 1.1-3.3), linking mechanical stress and degenerative remodeling to development and transformation. Without intervention, factors such as endplate microdamage and associated fibrovascular responses drive this evolution, with type 3 sclerotic changes representing a more chronic, less reversible stage. Longitudinal studies tracking MRI changes in untreated cohorts provide insight into this natural course through 2025. The Wakayama Spine Study, a 3-year prospective analysis of 678 community participants, reported a 11.7% incidence of new Modic changes and 2.5% transformation rate, predominantly at lower levels, confirming ongoing progression in the absence of . A 2025 clinical update synthesizing such data emphasizes that Modic changes co-evolve with disc degeneration over time, with inter-type conversions (particularly type 1 to 2) occurring dynamically but rarely reversing fully in non-intervened cases.

Long-term Outcomes

Patients with Type 1 Modic changes experience persistent at higher rates compared to those with other types or no Modic changes, with meta-analyses indicating an of 4.01 for association (p=0.04). Longitudinal studies further demonstrate that Type 1 changes correlate with constant and , contributing to ongoing symptoms in a significant proportion of cases, though exact persistence rates vary by . Additionally, the presence of Modic changes, particularly Type 1, is linked to increased risk relative to non-Modic , with affected individuals reporting higher Oswestry Disability Index scores and more frequent severe episodes. Treatment responses for Modic changes show limited efficacy with exercise or alone, as conservative approaches like often fail to address the underlying inflammatory component in Type 1 cases. In contrast, multimodal strategies incorporating basivertebral ablation or interventions yield better long-term pain relief and functional improvements, with significant reductions in Visual Analog Scale scores sustained up to 5 years in select trials (p<0.001). Early detection of Type 1 Modic changes serves as a key prognostic marker, predicting worse clinical outcomes including prolonged recovery and higher non-response rates to standard therapies. Recent 2025 research highlights emerging biomarkers which aid in forecasting chronicity and enabling personalized management approaches like targeted or novel agents. These findings underscore the potential for biomarker-driven stratification to improve prognosis in high-risk patients.

References

  1. [1]
    Modic changes - An evidence-based, narrative review on its patho ...
    Feb 17, 2025 · Modic changes (MC) are vertebral bone marrow signal intensity changes seen on MRI, commonly in association with degenerative disc disease (DDD).
  2. [2]
    Modic type endplate changes | Radiology Reference Article
    Jul 25, 2025 · Modic type endplate changes represent a classification for vertebral body endplate MRI signal changes 1. It is widely recognized by ...Modic type II endplate change · Modic type 1 endplate change · Diagram
  3. [3]
    Modic Changes as Biomarkers for Treatment of Chronic Low Back ...
    Jul 11, 2025 · Results: This review synthesizes current evidence on the classification, pathophysiology, and imaging of MCs, with a particular focus on their ...
  4. [4]
    The Modic Vertebral Endplate and Marrow Changes
    Modic changes are dynamic markers of the normal age-related degenerative process affecting the lumbar spine.
  5. [5]
    Incidence and risk factors for modic changes in the lumbar spine
    Jul 30, 2025 · Conclusion: Modic changes occur in 35% of lumbar spine cases, with advanced age, disc degeneration, endplate changes, spondylolisthesis, reduced ...
  6. [6]
    assessment of changes in vertebral body marrow with MR imaging
    These signal intensity changes appear to reflect a spectrum of vertebral body marrow changes associated with degenerative disk disease.
  7. [7]
    Modic changes: a systematic review of the literature - PMC - NIH
    Modic changes (MC) are a common phenomenon on magnetic resonance imaging (MRI) in spinal degenerative diseases and strongly linked with low back pain (LBP).
  8. [8]
    Pathobiology of Modic changes - PMC - PubMed Central - NIH
    Modic changes are adjacent to a degenerated intervertebral disc and have three generally interconvertible types suggesting that the different Modic change ...
  9. [9]
    [PDF] Pathobiology of Modic changes - eScholarship
    Nov 1, 2016 · Endplate damage causes a cascade of degenerative changes in both the vertebra and the disc. Endplate damage increases intraosseous pressure [42] ...<|separator|>
  10. [10]
    Prevalence of Modic changes in the lumbar vertebrae and their ...
    Apr 12, 2017 · Previous studies have reported that overweight plays a key role in the cause of disc degeneration and that it may also be associated with Modic ...
  11. [11]
    Strong association between vertebral endplate defect and Modic ...
    Nov 9, 2018 · The classification consists of progressive evaluation of disc degeneration, assessed from grade 1 (homogeneous disc with bright hyperintense ...
  12. [12]
    Pathologic Significance and The Modic Vertebral
    From this review, it appears that Modic changes are dynamic markers of the normal age-related degenerative process affect- ing the lumbar spine. These lesions ...
  13. [13]
    https://doi.org/10.1007/s00586-013-2977-0
  14. [14]
    Chronic Low Back pain, Modic Changes and low-grade Virulent ...
    Propionibacterium acnes infected intervertebral discs cause vertebral bone marrow lesions consistent with Modic changes. J. Orthop. Res.34(8), 1447–1455 ...
  15. [15]
    Bacteria: back pain, leg pain and Modic sign—a surgical multicentre ...
    Oct 1, 2019 · Modic changes in the adjacent vertebrae due to disc material infection with Propionibacterium acnes in patients with lumbar disc herniation.
  16. [16]
    https://doi.org/10.1016/j.spinee.2014.02.018
  17. [17]
    https://doi.org/10.3389/fcimb.2025.1449873
  18. [18]
    2bRAD-M reveals differences in microbial communities between ...
    Mar 20, 2025 · 2bRAD-M was performed to explore whether microbial differences existed between Modic change and herniated disc samples.
  19. [19]
    Antibiotic treatment in patients with chronic low back pain and ...
    The percentage of patients with grade 1 Modic changes (minute) 28.8 % of the placebo group and 10.4 % of the antibiotic group were noted, p = 0.006. At 1-year ...
  20. [20]
    Efficacy of antibiotic treatment in patients with chronic low back pain ...
    Oct 16, 2019 · This trial evaluated the efficacy and harm of three months of oral treatment with amoxicillin at one year follow-up in patients with chronic low back pain and ...
  21. [21]
    The efficacy and safety of oral antibiotic treatment in patients with ...
    Sep 19, 2023 · Low-quality evidence from meta-analyses of RCTs showed that oral antibiotic was significantly better than placebo in improving pain and disability in CLBP ...Abstract · INTRODUCTION · MATERIALS AND METHODS · RESULTS
  22. [22]
    Modic type 1 change is an autoimmune response that requires a ...
    Modic changes (MCs) are magnetic resonance imaging (MRI) evidence of inflammatory and fibrotic vertebral bone marrow lesions that associate with adjacent disc ...
  23. [23]
    Low back pain patients with Modic type 1 changes exhibit distinct ...
    Our study provides the first evidence for the existence of bacterial (C.acnes “high”) and non-bacterial (C.acnes “low”) subtypes in MC1 patients with CLBP.
  24. [24]
    The mechanisms and functions of TNF-α in intervertebral disc ...
    TNF-α activates the production of inflammatory factors such as NLRP3, IL-6, IL-8, and chemokines such as CCL3 and CCL5, amplifying the inflammatory response ...
  25. [25]
    Genetic factors are associated with modic changes in endplates of ...
    May 15, 2008 · Twin studies suggest that intervertebral disc degeneration may be primarily explained by genetic factors, but no data exist on genetic factors ...Missing: heritability | Show results with:heritability
  26. [26]
    The heritability and genetic risk factors of Modic changes - OuluREPO
    Nov 16, 2018 · The role of genetic factors in the development of lumbar DD has been demonstrated to be significant, with heritability estimates ranging from 64 ...
  27. [27]
    Modic change is associated with increased BMI but not autoimmune ...
    Aug 9, 2023 · No association was found between diagnosis of autoimmune disorder and MC. Interestingly, BMI was independently associated with MC width but not to MC ...
  28. [28]
    CCL3 correlates with ferroptosis in intervertebral disc degeneration ...
    Apr 9, 2025 · These genes encompass CCL3, CXCL3, CCL3L3, HLA-DRA, EREG, CXCL2 ... Association between modic changes, disc degeneration, and neck pain ...
  29. [29]
    Vertebral marrow adipose tissue adipokines as a possible cause of ...
    Association of increased body weight with LBP, IVDD and Modic changes are considered to be a result of (1) increased mechanical loads on the lumbar spine, (2) ...
  30. [30]
    Vertebral marrow adipose tissue adipokines as a possible cause of ...
    Hypertrophic vertebral marrow adipose tissue has recently been implicated as a source of inflammatory adipokines, which can cause degenerative changes in IVD ...
  31. [31]
    SMOKING AND MODIC CHANGES IN PATIENTS WITH CHRONIC ...
    Oct 28, 2024 · Self-reported hard physical work combined with heavy smoking or overweight may result in so-called Modic changes. BMC Musculoskelet Disord ...Table 2. Smokers Vs Modic · Table 3. Modic Distribution... · Figure 4. Modic Changes...
  32. [32]
    (PDF) Oxidative/Nitrosative Stress in Patients With Modic Changes
    Aug 6, 2025 · Objective: The aim of this study was to assess the levels of oxidative/nitrosative stress biomarkers in patients with MCs. Summary of background ...
  33. [33]
    Inflammation and macrophage polarization are associated with ...
    Modic changes are hypothesized to represent devascularization of the vertebral endplate, indicative for an environment that is receptive for inflammation.
  34. [34]
    Modic changes, possible causes and relation to low back pain
    ... Modic changes (MC) are common in patients with LBP (18-58%) and is strongly associated with LBP. In asymptomatic persons the prevalence is 12-13%. MC are ...
  35. [35]
    https://pmc.ncbi.nlm.nih.gov/articles/PMC11192140/
  36. [36]
    Lumbar Disc Herniation - StatPearls - NCBI Bookshelf
    The lumbar radicular pain arises when disc material exerts pressure or ... Degenerative disc diseases have shown a correlation with Modic type 1 changes.
  37. [37]
    Modic changes as seen on MRI are associated with nonspecific ...
    May 12, 2023 · Modic changes are associated with nonspecific chronic lower back pain and that type 1 Modic changes are more painful than type 2.
  38. [38]
    The Clinical Significance of the Modic Changes Grading Score - PMC
    A severe MC grade was associated with worse disability scores, reduced health-related quality of life, and the presence of severe lumbar disc degeneration.
  39. [39]
    A Study on 620 Patients With Two-year Follow-up - PubMed
    Nov 1, 2020 · Objective: To assess whether Modic changes (MCs) are associated with health-related quality of life, long-term physical disability, back- or leg ...
  40. [40]
    Association between MRI findings and inflammatory symptoms in ...
    Oct 22, 2025 · Bailly et al. found an association between Modic lesions and inflammatory pain pattern (defined as pain maximum in the morning, waking at night ...
  41. [41]
    Short-term pain evolution in chronic low back pain with Modic type 1 ...
    CRLB prescription concerned individuals with inflammatory pain, morning stiffness, night awakening pain, pain resistant to non-steroidal anti-inflammatory drugs ...
  42. [42]
    Inflammatory pain pattern and pain with lumbar extension ... - NIH
    Modic 1 changes are rare in an asymptomatic population and are frequently associated with low back pain (LBP) [4]. Subgrouping patients may be important because ...
  43. [43]
    Modic I changes size increase from supine to standing MRI ...
    Apr 15, 2019 · Our results showed the modifications of Modic I changes under loading, with MRI evidence of increased Modic changes area extent in the upright ...Abstract · Mri Protocol · Modic I Changes
  44. [44]
    Modic Changes Are Associated With Increased Pain Intensity ...
    Jun 5, 2025 · Modic Changes Are Associated With Increased Pain Intensity, Greater Disability, and Reduced Quality of Life in Low Back Pain: A Cross-Sectional ...
  45. [45]
    Detailed Subphenotyping of Lumbar Modic Changes and Their ...
    Nov 15, 2021 · The LBP VAS score was significantly higher in participants with Modic type I and I/II than in those with no Modic changes. The LBP VAS score was ...Lbp And Lbp Intensity · Evaluation Of Mri Results · Prevalence Of Modic Changes
  46. [46]
    Low back pain patients with Modic type 1 changes exhibit distinct ...
    Jan 18, 2024 · Modic type 1 changes (MC1) are vertebral endplate bone marrow (BM) lesions observed on magnetic resonance images in sub-populations of chronic low back pain ( ...
  47. [47]
    a systematic literature review of prevalence and association with ...
    The median of the reported prevalence rates for any type of VESC was 43% in patients with non-specific LBP and/or sciatica and 6% in non-clinical populations.Missing: chronic | Show results with:chronic
  48. [48]
    Incidence and risk factors for modic changes in the lumbar spine
    Modic changes are classified into three distinct types based on NMR manifestations: Type I is characterized by edema and inflammatory changes in the bone ...
  49. [49]
    Modic changes of the lumbar spine: prevalence, risk factors, and ...
    Jan 1, 2016 · Results: The overall prevalence of MC was 5.8% (n=141), which increased with advancing age. Modic changes predominantly occurred at the lowest ...Missing: chronic | Show results with:chronic
  50. [50]
    Modic changes of the lumbar spine: prevalence, risk factors, and ...
    Jan 1, 2016 · Majority of the MC occurred at the lowest two lumbar levels (83%), with L5/S1 (47%) being the most common level (Fig. 2). All disc levels with ...
  51. [51]
    Are Modic changes prognostic for recovery in a cohort of patients ...
    Results: Five percent had a normal MRI, 14 and 50% had Modic 1 and Modic 2 changes. Modic changes were not significant covariates for the clinical course of ...
  52. [52]
    Distribution of Modic changes in patients with low back pain and its ...
    Oct 9, 2019 · A total of 35 patients with type I changes, 110 patients with type II changes, and 8 patients with type III changes. In total, 204 disks were ...Modic Changes · Intervertebral Disk... · Disk Degeneration And Types
  53. [53]
    Self-reported hard physical work combined with heavy smoking or ...
    Jan 14, 2008 · Self-reported hard physical work combined with heavy smoking or overweight may result in so-called Modic changes.
  54. [54]
    Prevalence of and risk factors for Modic change in patients ... - NIH
    It appears that advanced age and high BMI were two factors that may be responsible for cervical MC. Type 1 MC is associated with the prevalence of neck pain.
  55. [55]
    Prevalence of and risk factors for Modic change in patients with sympt
    Feb 14, 2018 · Data were collected on potential risk factors in the following four categories: demographic data, lifestyle variables, laboratory tests, and ...<|control11|><|separator|>
  56. [56]
    Association Between Lumbar Disc Herniation and Vertebral...
    Our research findings indicate that lumbar disc herniation increases the risk of developing MCs, particularly Type II MCs. Furthermore, our study revealed that ...
  57. [57]
    Modic Type 1 Vertebral Endplate Changes: Injury, Inflammation, or ...
    Studies have attributed Modic type 1 vertebral endplate changes to traumatic injury to the vertebral endplate, localized action of proinflammatory mediators,
  58. [58]
    Prevalence, Patterns, and Genetic Association Analysis of Modic ...
    Aug 7, 2017 · The etiology of Modic changes (MCs) is unclear. Recently, the role of genetic factors in the etiology of MCs has been evaluated. However, ...
  59. [59]
    Is Diabetes Mellitus a Risk Factor for Modic Changes? - ResearchGate
    Patients with Modic changes at any lumbar level had significantly higher HbA1c percentages, and longer duration of DM than those without Modic changes.
  60. [60]
    Agreement in the Interpretation of Magnetic Resonance Images of ...
    Jul 21, 2009 · ... Modic changes in the anteroposterior axis (less than 25% of the endplate, between 25% and 50%, more than 50%), and maximum endplate area ...
  61. [61]
    Modic (endplate) changes in the lumbar spine: bone micro ...
    Jul 26, 2014 · Their study showed that in Modic type 3, the low T1 and T2 signals seen in MRI, corresponded to endplate bone sclerosis as indicated in the CT ...
  62. [62]
    Quantitative assessment of lumbar intervertebral disc degeneration ...
    Sep 1, 2025 · Quantitative MRI methods for T2* values and T2 mapping are associated with grade of degeneration and ODI index and are more effective for ...
  63. [63]
    Using A Quantitative Assessment Tool in Diffusion Weighted ...
    Nov 2, 2025 · Differentiating infectious spondylodiscitis from degenerative Modic type 1 changes using diffusion-weighted imaging and apparent diffusion ...
  64. [64]
    Differentiation between infectious spondylodiscitis versus ...
    Apr 2, 2021 · The distinction between a Modic 1 lesion and a spondylodiscitis can be made by the lack of abnormal disc signal or disc hypointensity on T2- ...
  65. [65]
    Spinal disorders mimicking infection | Insights into Imaging | Full Text
    Dec 4, 2021 · This review sought to illustrate the imaging pattern of spinal diseases mimicking an infection and to define characteristic MRI and CT patterns.
  66. [66]
    Diffusion-Weighted MRI “Claw Sign” Improves Differentiation of ...
    Aug 1, 2014 · This retrospective study analyzes the utility and accuracy of a novel, diffusion-weighted “claw sign” for distinguishing symptomatic type 1 degeneration from ...<|control11|><|separator|>
  67. [67]
    [PDF] MR Imaging for the Differentiation of Early Infectious Spondylitis and ...
    Toyone et al. (19) stated that 73% of patients with a Modic type I change had significant lower back pain. The differential diagnosis between infectious ...
  68. [68]
    comparison with Modic type-I end-plate changes and metastatic ...
    Imaging findings are usually advanced when the diagnosis is established; however imaging studies are useful for both the differential diagnosis and treatment ...
  69. [69]
    MRI of Spinal Bone Marrow: Part 2, T1-Weighted Imaging-Based ...
    The differential diagnosis includes normal variant, irradiated marrow, osteoporosis, heterogeneous fatty marrow, and multiple hemangiomas. Rare diagnoses that ...
  70. [70]
    Value for Predicting Presence of Ankylosing Spondylitis | AJR
    The most frequent feature of signal intensity was a Modic type II change (77%). In patients with ankylosing spondylitis, the MR corner sign was fre quently seen ...
  71. [71]
    Spinal Infections Unmasking the great imitators-noninfectious ...
    ... Modic changes in degenerative disc disease, Paget's disease, and psoas hematoma. Conclusion. Noninfectious spinal conditions can masquerade as spinal ...
  72. [72]
    Modic Changes in spine surgery: clinical update 2025
    Aug 28, 2025 · Modic changes (MC) denote a clinically meaningful vertebral endplate–marrow phenotype that co‑evolves with intervertebral disc degeneration.
  73. [73]
    Rest versus exercise as treatment for patients with low back pain ...
    Feb 29, 2012 · Exercise therapy is the recommended treatment for chronic LBP, however, due to their underlying pathology, Modic changes might be a diagnostic ...
  74. [74]
    Analyzing the Influence of Modic Changes on Patients with Lower ...
    Mar 19, 2019 · Three months after undergoing nonsurgical treatment, the rates of improved ODI and VAS scores were statistically significantly different (P = ...
  75. [75]
    Vertebrogenic low back pain: 2025 Solutions
    Oct 2, 2025 · It provides a detailed view inside your spine and can reveal specific changes in the vertebral endplates and bone marrow known as Modic changes.Missing: recognition | Show results with:recognition
  76. [76]
    Efficacy of Antibiotic Treatment for Patients With Chronic Low Back ...
    Aug 14, 2025 · Overview. The goal of this clinical trial is to learn if antibiotics (amoxicillin) work to treat chronic low back pain in adults.
  77. [77]
    Antibiotics for Back Pain: Does a New Study Doom a Highly...
    The researchers found a small, statistically significant advantage in the antibiotic treatment group—with a stronger effect in patients with type I Modic ...
  78. [78]
    Efficacy of stepped care treatment for chronic discogenic low back ...
    Modic changes and disc degeneration in adolescent idiopathic scoliosis patients who reach middle age without surgery: can residual deformity cause lumbar spine ...
  79. [79]
    Modic Changes - Physiopedia
    Modic changes (MC) are subchondral vertebral bone marrow changes and are identifiable with magnetic resonance imaging (MRI).Pathological Process and Risk... · Clinical Presentation<|control11|><|separator|>
  80. [80]
    Efficacy of a Tumor Necrosis Factor Inhibitor in Chronic Low‐Back ...
    Dec 3, 2024 · Efficacy of a tumor necrosis factor inhibitor in chronic low-back pain with Modic type 1 changes: a randomized controlled trial.
  81. [81]
    The effect of infliximab in patients with chronic low back pain and ...
    Oct 21, 2020 · This study examines the effect of anti-inflammatory treatment with the TNF-α inhibitor infliximab in patients with chronic low back pain and Modic changes.Missing: biologics | Show results with:biologics
  82. [82]
    Lumbar Disc Herniation and Preoperative Modic Changes
    Preoperative Modic changes in lumbar disc herniation is associated with less favorable back pain, functional scores and patient satisfaction in patients ...
  83. [83]
    Evaluating the Impact of Modic Changes on Operative Treatment in ...
    Most studies found that MCs did not significantly impact the clinical outcomes following lumbar fusion, lumbar discectomy, or lumbar disc replacement.
  84. [84]
    Evaluating the Impact of Modic Changes on Operative Treatment in ...
    Most studies found that MCs did not significantly impact the clinical outcomes following lumbar fusion, lumbar discectomy, or lumbar disc replacement.
  85. [85]
    The Modic change grade is associated with patient-reported ...
    Modic change grade has been identified as a clinically significant biomarker. · This study analyzed MCG in patients undergoing lumbar spinal stenosis surgery.The Modic Change Grade Is... · 2. Material And Methods · 3. Results
  86. [86]
    Presence of Modic type 1 change increases risk of postoperative ...
    Presence of Modic type 1 change increases risk of postoperative pyogenic discitis following decompression surgery for lumbar canal stenosis - ScienceDirect.
  87. [87]
    Association Of Modic Changes And Postoperative Surgical Site ...
    May 31, 2024 · This study aims to investigate the relation between Modic changes and surgical site infection after posterior lumbar fusion surgery. METHODS ...
  88. [88]
    A new surgical strategy for the intractable chronic low back pain due ...
    In this paper, we describe the first patient of type 1 Modic change who was successfully treated by the full-endoscopic intra-discal debridement and drainage ...
  89. [89]
    [PDF] Clinical Outcomes of Full-Endoscopic Disc Cleaning Surgery for ...
    Mar 5, 2025 · Modic changes (MCs), first described by Michael Modic in. 1988, represent pathological alterations in the vertebral end- plates and subchondral ...
  90. [90]
    The application of endoscopic debridement combined with ... - NIH
    Feb 25, 2025 · There were 13 cases of non-spinal infection, including spinal tumor in 3 cases, endplate Modic change in 6 cases, and endplate fracture in 4 ...
  91. [91]
    [PDF] The Modic change grade is associated with patient-reported ...
    Jul 8, 2025 · Objective: To evaluate the impact of the Modic Change Grade (MCG) on patient-reported outcomes (PROs) in patients undergoing lumbar spinal ...
  92. [92]
    Ten-Year Clinical Outcomes After Decompression Surgery for ...
    Jul 15, 2025 · ConclusionModic changes, particularly Type 2, are associated with inferior long-term outcomes. These findings suggest that Modic Type 2 may ...
  93. [93]
    Longitudinal study of vertebral type-1 end-plate changes ... - PubMed
    Forty-four patients with 48 Modic type-1 end-plate changes (low TI signal and high T2 signal) were studied. All patients had an initial and a follow-up non ...
  94. [94]
    The natural history of Modic changes in a community-based cohort
    Aug 7, 2025 · This study examined the natural history of Modic changes and their potential relationship to the intervertebral disc. Methods: Seventy-two ...
  95. [95]
    A Prospective, 3-year Longitudinal Study of Modic Changes of the ...
    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 ...
  96. [96]
    Modic Vertebral Body Changes The Natural History as Assessed by ...
    Aug 6, 2025 · A longitudinal follow-up of Modic changes on magnetic resonance imaging (MRI). To assess the prevalence and natural course Modic changes ...
  97. [97]
    Modic changes and their role in vertebrogenic back pain
    Nov 3, 2025 · MCs are classified into three types based on MRI characteristics, with the potential to present with mixed types or to interconvert over time.Modic Changes And Their Role... · Pathophysiology · Intradiscal Injection...
  98. [98]
    A Paradigm Shift in Diagnosis and Treatment of Axial Low Back Pain
    Jul 20, 2022 · Type 1 Modic changes are associated with bone marrow edema and hypervascularity of the vertebral body displayed as decreased signal intensity on ...
  99. [99]
    [PDF] Vertebral endplate (modic) changes and the treatment of back pain ...
    Vertebral endplate changes/modic changes (MC) are the MRI-images of inflammatory vertebral endplate damage that are often related to general disc degeneration. ...
  100. [100]
    https://doi.org/10.3892/mmr.2025.13455