Modic type I endplate change is the most controversial and important of the three types described (see Modic endplate change). It is seen on MRI of the spine and represents the presence of low T1 and high T2 signal within the bone marrow of a vertebral body adjacent to a disk. Type 1 change can enhance and be painful.
Modic type I changes are seen much more frequently in patients with low back pain (46%) compared to asymptomatic general population (6%) 1.
They are believed to be the result of fissuring of the endplates with the development of vascular granulation tissue adjacent to the endplates, resulting in bone marrow oedema 2.
This pattern is very similar to that seen in infection and merely represents bone marrow oedema. Without correlation with clinical parameters (symptoms, fever, inflammatory markers) it can be difficult to distinguish sterile Modic type I change from discitis/osteomyelitis. Highlighting this difficulty is the finding that a proportion of patients which what appears to be 'incidental' Modic type I change will go on to have proven discitis osteomyelitis by low virulence pathogens such as Staphylococcus epidermidis, Propionibacterium acnes, and diphtheroid species over protracted follow-up (4.2% over 2 year follow-up in one study 3).
More controversial is a 2013 study 4 which suggested that patients with isolated Modic I changes on imaging with only chronic lower back pain as a symptom (and no clinical or laboratory evidence of infection) responded clinically to protracted antibiotic administration with statistically significant improvement in disease-specific disability-RMDQ, leg pain and lumbar pain 4. The authors have coined the term Modic Antibiotic Spinal Therapy (MAST).
A 2015 review 6 of the subject found moderate evidence supporting a causal relationship between the presence of bacteria and Modic I changes, as well as with lower back pain. The authors, however, state that further research is required.
- 1. Jensen TS, Karppinen J, Sorensen JS et-al. Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J. 2008;17 (11): 1407-22. doi:10.1007/s00586-008-0770-2 - Free text at pubmed - Pubmed citation
- 2. Modic MT, Steinberg PM, Ross JS et-al. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988;166 (1 Pt 1): 193-9. Pubmed citation
- 3. Ohtori S, Koshi T, Yamashita M et-al. Existence of pyogenic spondylitis in Modic type 1 change without other signs of infection: 2-year follow-up. Eur Spine J. 2010;19 (7): 1200-5. doi:10.1007/s00586-010-1358-1 - Free text at pubmed - Pubmed citation
- 4. Albert HB, Sorensen JS, Christensen BS et-al. Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy. Eur Spine J. 2013;22 (4): 697-707. doi:10.1007/s00586-013-2675-y - Free text at pubmed - Pubmed citation
- 5. Urquhart DM, Zheng Y, Cheng AC et-al. Could low grade bacterial infection contribute to low back pain? A systematic review. BMC Med. 2015;13 (1): 13. doi:10.1186/s12916-015-0267-x - Free text at pubmed - Pubmed citation
- 6. McCartney M. Antibiotics for back pain: hope or hype?. BMJ. 2013;346 (may14 2): f3122. doi:10.1136/bmj.f3122 - Pubmed citation