ISSLS PRIZE in Clinical Science 2022: Epidemiology, risk factors and clinical impact of juvenile Modic changes in paediatric patients with low back pain.
Children
Disc degeneration
Endplate
MRI
Modic
Journal
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
ISSN: 1432-0932
Titre abrégé: Eur Spine J
Pays: Germany
ID NLM: 9301980
Informations de publication
Date de publication:
05 2022
05 2022
Historique:
received:
15
10
2021
accepted:
10
01
2022
revised:
15
10
2021
pubmed:
8
2
2022
medline:
21
5
2022
entrez:
7
2
2022
Statut:
ppublish
Résumé
It's a long-held belief that Modic changes (MC) occur only in adults, with advanced age, and are highly associated with pain and adverse outcomes. The following study addressed the epidemiology, risk factors and clinical relevance of MC in young paediatric patients. Two hundred and seven consecutive patients with no history of deformities, neoplasms, trauma, or infections were included in this ambispective study. MRIs were utilized to assess MCs and types, and other degenerative disc/endplate abnormalities. Subject demographics, duration of symptoms, clinic visits, conservative management (physical therapy, NSAIDs, opioids, injections) and surgery were noted. The mean age was 16.5 years old (46.9% males), 14% had MCs and they occurred throughout the spine. Subject baseline demographics were similar between MCs and non-MCs patients (p > 0.05). Modic type 2 (50%) was the most common type (type 1:27.1%; type 3:18.8%; mixed:4.7%). Multivariate analyses noted that endplate damage (OR: 11.36), disc degeneration (OR: 5.81), disc space narrowing (OR: 5.77), Schmorl's nodes (OR: 4.30) and spondylolisthesis (OR: 3.55) to be significantly associated with MCs (p < 0.05). No significant differences in conservative management were noted between Modic and non-MCs patients (p > 0.05). Among surgery patients (n = 44), 21% also had MCs (p = 0.134). Symptom-duration was significantly greater in MC patients (p = 0.049). Contrary to traditional dogma, robust evidence now exists noting that MCs and their types can develop in children. Our findings give credence to the "Juvenile" variant of MCs, whereby its implications throughout the lifespan need to be assessed. Juvenile MCs have prolonged symptoms and related to specific structural spine phenotypes.
Identifiants
pubmed: 35129673
doi: 10.1007/s00586-022-07125-x
pii: 10.1007/s00586-022-07125-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1069-1079Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Disease GBD, Injury I, Prevalence C (2018) Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 392(10159):1789–1858. https://doi.org/10.1016/S0140-6736(18)32279-7
doi: 10.1016/S0140-6736(18)32279-7
Katz JN (2006) Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am 88(Suppl 2):21–4. https://doi.org/10.2106/JBJS.E.01273
doi: 10.2106/JBJS.E.01273
pubmed: 16595438
Rahme R, Moussa R (2008) The modic vertebral endplate and marrow changes: pathologic significance and relation to low back pain and segmental instability of the lumbar spine. Am J Neuroradiol 29(5):838–842. https://doi.org/10.3174/ajnr.A0925
doi: 10.3174/ajnr.A0925
pubmed: 18272564
pmcid: 8128601
Modic MT, Steinberg PM, Ross JS et al (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166:193–199. https://doi.org/10.1148/radiology.166.1.3336678
doi: 10.1148/radiology.166.1.3336678
pubmed: 3336678
Dudli S, Fields AJ, Samartzis D et al (2016) Pathobiology of modic changes. Eur Spine J 25(11):3723–3734. https://doi.org/10.1007/s00586-016-4459-7
doi: 10.1007/s00586-016-4459-7
pubmed: 26914098
Mok FP, Samartzis D, Karppinen J et al (2016) Modic changes of the lumbar spine: prevalence, risk factors, and association with disc degeneration and low back pain in a large-scale population-based cohort. Spine J 16(1):32–41. https://doi.org/10.1016/j.spinee.2015.09.060
doi: 10.1016/j.spinee.2015.09.060
pubmed: 26456851
Thompson KJ, Dagher AP, Eckel TS et al (2009) Modic changes on MR images as studied with provocative diskography: clinical relevance–a retrospective study of 2457 disks. Radiology 250(3):849–855. https://doi.org/10.1148/radiol.2503080474
doi: 10.1148/radiol.2503080474
pubmed: 19244050
Baker JD, Harada GK, Tao Y et al (2020) The impact of modic changes on preoperative symptoms and clinical outcomes in anterior cervical discectomy and fusion patients. Neurospine. 17(1):190–203. https://doi.org/10.14245/ns.2040062.031
doi: 10.14245/ns.2040062.031
pubmed: 32252168
pmcid: 7136113
Hwang J, Louie PK, Phillips FM et al (2019) Low back pain in children: a rising concern. Eur Spine J 28(2):211–213. https://doi.org/10.1007/s00586-018-5844-1
doi: 10.1007/s00586-018-5844-1
pubmed: 30506290
Taimela S, Kujala UM, Salminen JJ et al (1997) The prevalence of low back pain among children and adolescents a nationwide, cohort based questionnaire survey in Finland. Spine (Phila Pa 1976) 22(10):1132–1136. https://doi.org/10.1097/00007632-199705150-00013
doi: 10.1097/00007632-199705150-00013
Swain MS, Henschke N, Kamper SJ et al (2014) An international survey of pain in adolescents. BMC Public Health 14:447. https://doi.org/10.1186/1471-2458-14-447
doi: 10.1186/1471-2458-14-447
pubmed: 24885027
pmcid: 4046513
King S, Chambers CT, Huguet A et al (2011) The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain 152(12):2729–2738. https://doi.org/10.1016/j.pain.2011.07.016
doi: 10.1016/j.pain.2011.07.016
pubmed: 22078064
Balague F, Troussier B, Salminen JJ (1999) Non-specific low back pain in children and adolescents: risk factors. Eur Spine J 8(6):429–438. https://doi.org/10.1007/s005860050201
doi: 10.1007/s005860050201
pubmed: 10664299
pmcid: 3611213
Smith A, Hancock M, O’Hanlon S et al (2021) The association between different trajectories of low back pain and degenerative imaging findings in young adult participants within the raine study. Spine (Phila Pa 1976). https://doi.org/10.1097/BRS.0000000000004171
doi: 10.1097/BRS.0000000000004171
Pfirrmann CW, Metzdorf A, Zanetti M et al (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 26(17):1873–1887. https://doi.org/10.1097/00007632-200109010-00011
doi: 10.1097/00007632-200109010-00011
Perera RS, Dissanayake PH, Senarath U et al (2017) Associations between disc space narrowing, anterior osteophytes and disability in chronic mechanical low back pain: a cross sectional study. BMC Musculoskelet Disord 18(1):193. https://doi.org/10.1186/s12891-017-1562-9
doi: 10.1186/s12891-017-1562-9
pubmed: 28506227
pmcid: 5433079
Fardon DF, Williams AL, Dohring EJ et al (2014) Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the North American Spine Society, the American Society of spine radiology and the American society of neuroradiology. Spine J 14(11):2525–2545. https://doi.org/10.1016/j.spinee.2014.04.022
doi: 10.1016/j.spinee.2014.04.022
pubmed: 24768732
Li Y, Karppinen J, Cheah KSE et al (2021) Integrative analysis of metabolomic, genomic, and imaging-based phenotypes identify very-low-density lipoprotein as a potential risk factor for lumbar Modic changes. Eur Spine J. https://doi.org/10.1007/s00586-021-06995-x
doi: 10.1007/s00586-021-06995-x
pubmed: 34822018
CDC Growth Charts Centers for Disease Control and Prevention2016 [updated Decemeber 7, 2016; cited 2021 January 15th]. Available from: http://www.cdc.gov/growthcharts/ .
Samartzis D, Karppinen J, Mok F et al (2011) A population-based study of juvenile disc degeneration and its association with overweight and obesity, low back pain, and diminished functional status. J Bone Joint Surg Am 93(7):662–670. https://doi.org/10.2106/JBJS.I.01568
doi: 10.2106/JBJS.I.01568
pubmed: 21471420
Wan ZY, Zhang J, Shan H et al (2021) Epidemiology of lumbar degenerative phenotypes of children and adolescents: a large-scale imaging study. Global Spine J. https://doi.org/10.1177/21925682211000707
doi: 10.1177/21925682211000707
pubmed: 33843321
Urrutia J, Zamora T, Prada C (2016) The prevalence of degenerative or incidental findings in the lumbar spine of pediatric patients: a study using magnetic resonance imaging as a screening tool. Eur Spine J 25(2):596–601. https://doi.org/10.1007/s00586-015-4099-3
doi: 10.1007/s00586-015-4099-3
pubmed: 26153679
van den Heuvel MM, Oei EHG, Renkens JJM et al (2021) Structural spinal abnormalities on MRI and associations with weight status in a general pediatric population. Spine J 21(3):465–476. https://doi.org/10.1016/j.spinee.2020.10.003
doi: 10.1016/j.spinee.2020.10.003
pubmed: 33045416
Eksi MS, Ozcan-Eksi EE, Ozmen BB et al (2020) Lumbar intervertebral disc degeneration, end-plates and paraspinal muscle changes in children and adolescents with low-back pain. J Pediatr Orthop B. https://doi.org/10.1097/BPB.0000000000000833.3
doi: 10.1097/BPB.0000000000000833.3
Eskola PJ, Kjaer P, Daavittila IM et al (2010) Genetic risk factors of disc degeneration among 12–14-year-old Danish children: a population study. Int J Mol Epidemiol Genet. 1(2):158–165
pubmed: 21537388
pmcid: 3076758
2015 G. (2016) Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet.388(10053):1545–602. doi: https://doi.org/10.1016/s0140-6736(16)31678-6 .
Zehra U, Bow C, Lotz JC et al (2018) Structural vertebral endplate nomenclature and etiology: a study by the ISSLS spinal phenotype focus group. Eur Spine J 27(1):2–12. https://doi.org/10.1007/s00586-017-5292-3
doi: 10.1007/s00586-017-5292-3
pubmed: 28900744
Zehra U, Robson-Brown K, Adams MA et al (2015) Porosity and thickness of the vertebral endplate depend on local mechanical loading. Spine. 40(15):1173–1180. https://doi.org/10.1097/brs.0000000000000925
doi: 10.1097/brs.0000000000000925
pubmed: 25893360
Herlin C, Kjaer P, Espeland A, et al. (2018) Modic changes-Their associations with low back pain and activity limitation: A systematic literature review and meta-analysis. PLoS One.13(8):e0200677. Epub 2018/08/02. doi: https://doi.org/10.1371/journal.pone.0200677 . PubMed PMID: 30067777; PubMed Central PMCID: PMCPMC6070210 CLY, JN, JSoS, KS, TSJ. JK: Paid lectures by MSD and Pfizer, Stocks of Orion Pharma Ltd, Membership of Scientific Advisory Board of Axsome Therapeutics Inc.
Kjaer P, Korsholm L, Bendix T et al (2006) Modic changes and their associations with clinical findings. Eur Spine J 15(9):1312–1319
doi: 10.1007/s00586-006-0185-x
Jensen TS, Karppinen J, Sorensen JS et al (2008) Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J. 17(11):1407–1422. https://doi.org/10.1007/s00586-008-0770-2
doi: 10.1007/s00586-008-0770-2
pubmed: 18787845
pmcid: 2583186
Jensen TS, Bendix T, Sorensen JS et al (2009) Characteristics and natural course of vertebral endplate signal (Modic) changes in the Danish general population. BMC Musculoskelet Disord. 10:81. https://doi.org/10.1186/1471-2474-10-81
doi: 10.1186/1471-2474-10-81
pubmed: 19575784
pmcid: 2713204
Jensen OK, Nielsen CV, Sørensen JS et al (2014) Type 1 Modic changes was a significant risk factor for 1-year outcome in sick-listed low back pain patients: a nested cohort study using magnetic resonance imaging of the lumbar spine. Spine J. 14(11):2568–2581. https://doi.org/10.1016/j.spinee.2014.02.01
doi: 10.1016/j.spinee.2014.02.01
pubmed: 24534386
Esposito P, Pinheiro-Franco JL, Froelich S et al (2006) Predictive value of MRI vertebral end-plate signal changes (Modic) on outcome of surgically treated degenerative disc disease. results of a cohort study including patients. Neurochirurgie. 52(4):315–322. https://doi.org/10.1016/s0028-3770(06)71225-5
doi: 10.1016/s0028-3770(06)71225-5
pubmed: 17088711
Freidin M, Kraatari M, Skarp S et al (2019) Genome-wide meta-analysis identifies genetic locus on chromosome 9 associated with modic changes. J Med Genet 56(7):420–426. https://doi.org/10.1136/jmedgenet-2018-105726
doi: 10.1136/jmedgenet-2018-105726
pubmed: 30808802
Albert HB, Kjaer P, Jensen TS et al (2008) Modic changes, possible causes and relation to low back pain. Med Hypotheses. 70(2):361–8. https://doi.org/10.1016/j.mehy.2007.05.014
doi: 10.1016/j.mehy.2007.05.014
pubmed: 17624684
Ohshima H, Urban JP (1992) The effect of lactate and pH on proteoglycan and protein synthesis rates in the intervertebral disc. Spine (Phila Pa 1976) 17(9):1079–82. https://doi.org/10.1097/00007632-199209000-00012
doi: 10.1097/00007632-199209000-00012
Baker JD, Sayari AJ, Harada GK et al (2021) The Modic-endplate-complex phenotype in cervical spine patients: association with symptoms and outcomes. J Orthop Res. https://doi.org/10.1002/jor.25042
doi: 10.1002/jor.25042
pubmed: 33749924
Mok FP, Samartzis D, Karppinen J et al (2010) ISSLS prize winner: prevalence, determinants, and association of Schmorl nodes of the lumbar spine with disc degeneration: a population-based study of 2449 individuals. Spine (Phila Pa 1976) 35(21):1944–1952. https://doi.org/10.1097/BRS.0b013e3181d534f3
doi: 10.1097/BRS.0b013e3181d534f3
Zehra U, Cheung JPY, Bow C et al (2019) Multidimensional vertebral endplate defects are associated with disc degeneration, modic changes, facet joint abnormalities, and pain. J Orthop Res. 37(5):1080–1089. https://doi.org/10.1002/jor.24195
doi: 10.1002/jor.24195
pubmed: 30515862
Wang Y, Videman T, Battie MC (2012) ISSLS prize winner Lumbar vertebral endplate lesions: associations with disc degeneration and back pain history. Spine (Phila Pa 1976) 37(17):1490–1496. https://doi.org/10.1097/BRS.0b013e3182608ac4
doi: 10.1097/BRS.0b013e3182608ac4
Rajasekaran S, Kanna RM, Reddy RR et al (2016) How reliable are the reported genetic associations in disc degeneration?: the influence of phenotypes, age, population size, and inclusion sequence in 809 patients. Spine (Phila Pa 1976) 41(21):1649–1660. https://doi.org/10.1097/BRS.0000000000001847
doi: 10.1097/BRS.0000000000001847
Karppinen J, Daavittila I, Solovieva S et al (2008) Genetic factors are associated with modic changes in endplates of lumbar vertebral bodies. Spine (Phila Pa 1976) 33(11):1236–1241. https://doi.org/10.1097/BRS.0b013e318170fd0e
doi: 10.1097/BRS.0b013e318170fd0e
Lenke LG, Betz RR, Harms J et al (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83(8):1169–1181
doi: 10.2106/00004623-200108000-00006