SPINE. Publish Ahead of Print():, MAR 2019
DOI: 10.1097/BRS.0000000000003051 ,
PMID: 30985571
Issn Print: Model.IssnPrint
Publication Date: 2019/03/01
Peter Udby
Abstract
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.
Level of evidence: 2