Modic changes are abnormal signal changes seen on lumbar MRI that reflect microscopic changes in the endplate tissue due to degeneration. There are three types of Modic changes (classified by Modic et al) that have different histopathological correlates and appearances on MRI: Type 1 represents bone marrow edema/inflammation, Type 2 represents marrow ischemia/fatty conversion, and Type 3 represents subchondral bone sclerosis. The relationship between Modic changes and low back pain has been studied but is still unclear. Conversion between types can occur over time and is associated with factors like age. Clinical interventions like surgery may influence Modic changes, but more research is still needed to fully understand these relationships and prognostic implications.

1. Modic
Changes
Dr Tejasvi Agarwal
Consultant Spine Surgeon

5. Definition:
 Modic changes are a common abnormal signal
change in lumbar MRI, reflecting the microscopic
changes in tissue biochemistry in the endplate, which
is an early manifestation of endplate degeneration.
 The concept of Modic changes has been in existence
for more than 30 years; however, the specific
mechanism still remains unknown.

6.  The relationship between it and LBP has been widely
studied.
 Most scholars believe that there is a connection.
 However, no clinical study has been conducted to
investigate the relevant factors associated with
different types of Modic changes.

7. Classification(Modic et al)
Three Modic changes have been
classified, each with different
histopathologic correlates:

8. Modic type 1
change represents
bone marrow
edema and
inflammation;
Hypointense on
T1WI and
hyperintense on
T2WI;

9. Modic type 2 change
represents marrow
ischemia and the
conversion of normal red
haemopoietic bone
marrow into yellow fatty
marrow.
type II—hyperintense on
T1WI and
isointense or mildly
hyperintense on T2WI;

10.  Modic type 3
change is rare
and represents of
subchondral
bone sclerosis.
 hypointense on
both T1WI and
T2WI

11. Natural history and conversion between
patterns:
Most of new MC were found also at L4–L5 or L5–S1, and co-
localized with a symptomatic disc herniation.
According to the current literature, the interconversion among
type 0, I and II possibly occur.
The conversion of type I to II is most common and the time
span of different conversion is at least 1 year.
MC type I appear to be more fluid and variable and will
become seriously or convert into type II in most cases,
whereas MC type II appear to be a more stable state.

12. • Young patients are closely associated with
type I changes.
• There may a transformation between two
types, type I can convert to type II with the
increasing of age.

13. Clinical intervention and
prognosis
 As different types of MC may have different
clinical significances, the influence of clinical
intervention on MC has been evaluated
regarding surgical and conservative
treatment.

14.  In the study of Lang et al it was suggested that the
occurrence of MC type I are the signs of the
pseudoarthrosis formation by evaluating segmental
spinal instability in 33 patients after spinal fusion.
 This result was consistent with the observation of
Buttermann et al that non-fusion was associated
predominantly with the persistence of MC type I.

15. Mechanisms
and
conversion of
MC and effects
of
clinical
intervention
(adapted
from Vital et al.

17. Differential diagnosis
1. Spondylodiscitis:
 Surrounding paravertebral soft-tissue edema or epidural
mass effect.
 The erosion of vertebral body and endplates are always
observed in intervertebral disk space infection.
2. Schmorl’s node
3. Metastasis

18. Conclusion:
There is no substantial evidence of MC
and relationship to its symptoms,
although MC have been strongly
associated with LBP according to
current evidence.

19. Thank you