Modic End Plate Changes of Spine With Classification
Q: Dear doctor, since 3 years I have been suffering from backache. On 24th February 2011, I took an MRI scan of lumbar spine. Its result is shown below:
At L1-L2, L2-L3 and L3-L4 no disc desiccation seen. Discs show no significant bulge/herniation. No evidence of significant primary canal / foraminal stenosis seen.
At L4-L5 disc desiccation seen with reduced disc height. Para-discal bone marrow appears hypointense on T1W , hyperintense on T2W images – suggestive of modic type I changes. Posterior disc protrusion causing significant spinal canal and bilateral foraminal stenosis with compression of the exiting nerve roots.
At L5-S1 no disc desiccation seen. Posterior annular disc bulge causing bilateral foraminal stenosis and mild spinal canal stenosis.
Vertebral alignment appears normal. No evidence of spondylolisthesis seen.
Vertebral bodies, pedicles, laminae, spinous processes and facetal articulation appear normal. Normal marrow signal intensity preserved.
Mid sagittal spinal canal measurement .
L1-L2–17 mm L2–14 mm
L2-L3–16 mm L3–14 mm
L3-L4–15 mm L4–13 mm
L4-L5–11 mm L5–13 mm
Sir in this case, I am eagerly waiting your precious suggestions. Kindly inform me if surgery is its only remedy? We have so many doubts whether the operation would be success or not. Can you suggest any good doctor in Kerala?
It is evident from your MRI that you are having a lot of back pain.
What Are Modic Changes?
Let us first know what these modic changes are. These are vertebral endplate and subchondral bone marrow changes due to the degeneration of discs. These are observed on MRI as signal intensity changes in vertebral body near the end plates of the affected discs.
With increasing age and repeated stress, wear and tear occurs in our back. This includes:
- Wearing out of the cushions provided between two vertebrae
- Shortening of the height between two vertebrae
- Minor fractures in the bony areas (like trabeculae) of the vertebrae
- Presence of signs of inflammations in the area, that is swelling etc.
- Later on, fat tissue may get deposited
- Inflammation finally leads to bone scarring
Pathologically, these changes are called modic changes and are grouped into 3 types.
i) Modic type 1 changes show signs of active inflammation. These signs are pain, presence of minor fractures and other breakages near the endplate area, accumulation of inflammatory fluid in the region leading to swelling. This stage is very painful and the pain usually correlates with the amount of inflammation.
ii) Modic type 2 is when the marrow gets substituted by yellow fat.
iii) Modic type 3 is the stage where all inflammation is finally replaced by bone scarring.
Since your MRI is showing modic type 1 changes, you have active inflammation in your back adjacent to end plates, which is giving you the pain.
Management of Backpain in Lumbar Vertebral Area
It won’t be proper to rush for surgery. Strong anti-inflammatory medication needs to be tried first.
It is something like you have many blisters there. Give yourself adequate rest. Don’t strain that part in any way. Avoid all movements that give you pain. You may also read here about the management of backache.
We are unable to suggest you a doctor at your place. However, it is advisable that you visit an orthopedician, preferably in a big hospital or institutional setup, not a solo clinic.
Hospitals are adequately equipped to meet emergencies. Also, there are people from other fields too, like neurology etc., who may be consulted during your treatment.
Your doctor may start with anti-inflammatory drugs first. This includes NSAIDs and corticosteroids.
He may consider giving you intradiscal injections of corticosteroids. 3 to 4 such injection are usually enough to take care of such inflammations.
Muscles relaxants are also given. SerratioPeptidase is a potent anti-inflammatory enzyme helpful in such conditions.
Surgery in this area is difficult and is suggested only when there is substantial herniation of the intervertebral disc tissue.