Modic Changes are not Associated with Long-Term Pain and Disability - A Cohort Study With 13-Year Follow-up

Peter Muhareb Udby, Tom Bendix, Søren Ohrt-Nissen, Michael Ruud Lassen, Joan Solgaard Sørensen, Stig Brorson, Leah Y Carreon, Mikkel Østerheden Andersen
Spine 2019 March 26

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 2004-2005, patients aged 18-60 with daily LBP were enrolled in an RCT study and lumbar MRI was performed. Patients completed numeric rating scales (NRS, 0-10) for LBP and leg pain (LP), Roland-Morris Disability Questionnaire (RMDQ), LBP Rating Scale for activity limitations (RS, 0-30), Inflammatory pain pattern (IPP) 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, LP and IPP 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 to 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 to the -MC group (22.9 days, 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.



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