Longitudinal study of vertebral type-1 end-plate changes on MR of the lumbar spine

The purpose of this study was to investigate the temporal evolution of type-1 end-plate changes on MRI in patients with degenerative disease of the lumbar spine and to evaluate whether any correlation exists between such evolution and the change in patients’ symptoms. 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-contrast lumbar MRI with variable intervals between the studies (12–72 months). Severity of the end-plate changes was assessed by eyeball estimation. Correlation with patients’ symptoms was studied with the help of the Visual Analogue Score (VAS), Oswestry Questionnaire Score (OQS) and patients’ subjective assessment. Of the 48 disc levels with type-1 changes, 18 (37.5%) converted fully to type 2 (high T1 signal and intermediate to high T2 signal), 7 (14.6%) partially converted to type 2, 19 (39.6%) became worse (i.e. type 1 changes became more extensive) and 4 (8.3%) showed no change. Higher average VAS (5.7) and OQS (42.3) scores were noted in patients where there was worsening type-1 change and lower scores (3.8 and 27, respectively) were seen in those where there was conversion to type-2 change. These trends, however, did not reach statistical significance (P values 0.16 and 0.09 for VAS and OQS, respectively). The statistical relationship was stronger after exclusion of patients with confounding factors (i.e. changes in lumbar MRI other than end-plate changes that could independently explain the evolution of patients’ symptoms) with P-values of 0.08 and 0.07 for VAS and OQS, respectively. Type-1 end-plate change represents a dynamic process and in a large majority of cases either converts to type-2 change or becomes more extensive. The evolution of type-1 change relates to change in patient’s symptoms, but not to a statistically significant level.

[1]  S. Mellgren,et al.  The Inflammatory Properties of Contained and Noncontained Lumbar Disc Herniation , 1997, Spine.

[2]  P. Renton,et al.  Vertebral end-plate (Modic) changes on lumbar spine MRI: correlation with pain reproduction at lumbar discography , 1998, European Spine Journal.

[3]  H. Genant,et al.  Lumbar spinal fusion. Assessment of functional stability with magnetic resonance imaging. , 1990, Spine.

[4]  T. Kakiuchi,et al.  Inflammatory Cytokines in the Herniated Disc of the Lumbar Spine , 1996, Spine.

[5]  R. Deyo,et al.  Lumbar spinal fusion. A cohort study of complications, reoperations, and resource use in the Medicare population. , 1993, Spine.

[6]  M. Zanetti,et al.  MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. , 1998, Radiology.

[7]  J. Fitzpatrick,et al.  Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. , 2002, The Journal of bone and joint surgery. British volume.

[8]  K. Schellhas,et al.  Lumbar Disc High‐intensity Zone: Correlation of Magnetic Resonance Imaging and Discography , 1996, Spine.

[9]  C. Pfirrmann,et al.  Painful Lumbar Disk Derangement: Relevance of Endplate Abnormalities at MR Imaging. , 2001, Radiology.

[10]  A. Roos,et al.  MR imaging of marrow changes adjacent to end plates in degenerative lumbar disk disease. , 1987, AJR. American journal of roentgenology.

[11]  H. Moriya,et al.  Vertebral bone-marrow changes in degenerative lumbar disc disease. An MRI study of 74 patients with low back pain. , 1994, The Journal of bone and joint surgery. British volume.

[12]  James D. Kang,et al.  Herniated Lumbar Intervertebral Discs Spontaneously Produce Matrix Metalloproteinases, Nitric Oxide, Interleukin-6, and Prostaglandin E2 , 1996, Spine.

[13]  F. Greco,et al.  Cytokines and growth factors in the protruded intervertebral disc of the lumbar spine , 2002, European Spine Journal.

[14]  J C Fairbank,et al.  The Oswestry low back pain disability questionnaire. , 1980, Physiotherapy.

[15]  Lieven Danneels,et al.  The Oswestry Low Back Pain Questionnaire als waardevolle aanvulling bij de evaluatie van de lage rug patiënt. , 2000 .

[16]  M. Zanetti,et al.  MR abnormalities of the intervertebral disks and adjacent bone marrow as predictors of segmental instability of the lumbar spine , 1998, Acta radiologica.

[17]  T J Masaryk,et al.  Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. , 1988, Radiology.

[18]  H. V. Crock.  The Presidential Address: ISSLS: Internal Disc Disruption A Challenge to Disc Prolapse Fifty Years On , 1986, Spine.

[19]  James D. Kang,et al.  Herniated Cervical Intervertebral Discs Spontaneously Produce Matrix Metalloproteinases, Nitric Oxide, Interleukin‐6, and Prostaglandin E2 , 1995, Spine.

[20]  M. Modic,et al.  Imaging of degenerative disk disease. , 1988, Radiology.

[21]  H. V. Crock.  Internal Disc Disruption , 1993 .