What are Modic changes?
Modic change refer to pathological and structural changes within vertebral bone.The condition is named after Dr Michael Modic, who identified these findings in 1988. He established that these changes can be readily identified through specific MRI scans. By excising bone samples from patients, he concluded that Modic changes to the spine could be classed into three specific disorder types.
As a back pain sufferer, what do you need to know about Modic changes?
Numerous studies have shown that there is a clear correlation between having Modic changes in spinal vertebrae and suffering back pain - particularly in Modic change Type 1. Several studies have established that patients with Modic changes have more severe pain than patients with "normal" back pain caused by usual spine and muscular strains, where the bone tissue remains normal. 75-80% of patients with Modic changes suffer from constant back pain. The intensity of the pain may vary during the day in relation to physical activity, but it never subsides completely. 68% of people identified with Modic changes are so afflicted with pain at night that when they turn over in their sleep they are woken up due to back pain.
In a healthy spine, bone has a scaffolding of tiny threads of bone. The spaces between these bone-threads are filled with red bone marrow, which produces blood cells.
Figure 1: Bone structure in a normal vertebra.
The 3 different types of Modic change.
Modic change Type 1
In Modic change Type 1, many of the tiny bone-threads are fractured (microfractures), becoming shorter and wider than normal. This results in an uneven bone structure. Instead of healthy red bone marrow, the spaces between the bone-threads have been replaced with a clear liquid, similar to that found in a blister. Additionally, new nerve fibres, which transmit pain, have grown into the bone.
Figure 2: MRI scan images of Modic changes Type 1 Both images are from the same person, but there is a difference in setting on the MRI scanner. The Modic changes are more readily seen on the scan labelled T2 on the left.
Modic change Type 2
MRI images of a person with Modic changes Type 2, the images are from the same person but the setting of the MRI-scanner is different.
Modic change Type 3.
MRI images with Modic changes Type 3 Both images are from the same person, but there is a difference in setting on the MRI scanner.
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