Asian Journal of Orthopaedic Research

Postoperative Modic Changes: What do We Know?

Nicolas Nicolas

Department of Orthopedic Surgery, Grand Hôpital de l'Est Francilien, Meaux, France.

Bassil F. Georges

Department of Orthopedic Surgery, Grand Hôpital de l'Est Francilien, Meaux, France and Department of Orthopedics and Traumatology, Faculty of Medicine, Lebanese University, Beirut, Lebanon.

Sleiman Mohamad Ali

Department of Orthopedics and Traumatology, Faculty of Medicine, Lebanese University, Beirut, Lebanon.

Nader Fadi *

Department of Orthopedic Surgery, Grand Hôpital de l'Est Francilien, Meaux, France and Department of Orthopedics and Traumatology, Faculty of Medicine, Lebanese University, Beirut, Lebanon and Department of Orthopedics and Trauma, Université Paris Cité, Paris, France.

*Author to whom correspondence should be addressed.

---

Abstract

Modic changes (MC), initially classified by Modic in 1988, consist of three types: MC1 (hyperintense on T2 weighted imaging T2WI), MC2 (hyperintense on T1 weighted imaging T1WI), and MC3 (hypointense on both T1WI and T2WI). These types are believed to represent different stages of the same disease, potentially resulting from persistent inflammation, altered healing, chronic inflammation, high bone turnover, and fibrosis.

In the postoperative setting, Modic changes can be influenced by different types of spinal surgeries such as lumbar spine fusion, lumbar disc surgery, cervical disc surgery, and scoliosis surgery. The impact of these surgical procedures on Modic changes varies depending on the specific technique employed.

Following lumbar disc surgery, the natural progression of Modic changes can be affected. It has been observed that certain surgical approaches, such as limited discectomy, may slow down the process of Modic changes. On the other hand, lumbar spine fusion, particularly posterior lumbar interbody fusion (PLIF), does not appear to prevent the development of Modic changes.

In the case of cervical disc surgery, the extent of disc resection and the surgical approach employed can have implications for Modic changes. Limited surgical techniques and approaches, which involve less extensive disc resection, have shown better outcomes in terms of Modic changes compared to broader disc resection procedures.

The surgical correction of scoliosis aims to restore spinal alignment and balance by fusing the vertebrae together. This fusion process can lead to changes in the adjacent vertebral segments, including the development of Modic changes. The altered biomechanics and stress patterns resulting from spinal fusion may contribute to the occurrence or progression of Modic changes in the postoperative period.

Overall, the impact of different spinal surgeries on Modic changes is complex and can vary depending on the specific procedure performed. Further research is needed to better understand the relationship between these surgical interventions and the development or progression of Modic changes in the postoperative period.

Keywords: Modic changes, post-operative, back pain, MRI

---

---

---

References

A. de Roos, Kressel H, Spritzer C, Dalinka M, MR imaging of marrow changes adjacent to end plates in degenerative lumbar disk disease, American Journal of Roentgenology. 1987;149(03):531–534. DOI: 10.2214/ajr.149.3.531

Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR, Degenerative disk disease: Assessment of changes in vertebral body marrow with MR imaging., Radiology. 1988;166(1):193–199. DOI: 10.1148/radiology.166.1.3336678

Braithwaite I, White J, Saifuddin A, Renton P, Taylor BA. Vertebral end-plate (Modic) changes on lumbar spine MRI: correlation with pain reproduction at lumbar discography, European Spine Journal. 1998;7(5):363–368. DOI: 10.1007/s005860050091

Kristoffersen PM et al. Short tau inversion recovery MRI of Modic changes: a reliability study, Acta Radiol Open. 2020;9(1):205846012090240. DOI: 10.1177/2058460120902402

Mitra D, Cassar-Pullicino VN, Mccall IW, Longitudinal study of vertebral type-1 end-plate changes on MR of the lumbar spine, Eur Radiol. 2004;14(9). DOI: 10.1007/s00330-004-2314-4

Kuisma M et al. Modic Changes in Endplates of Lumbar Vertebral Bodies, Spine (Phila Pa 1976). 2007;32(10):1116–1122. DOI: 10.1097/01.brs.0000261561.12944.ff

Kjaer P, Korsholm L, Bendix T, Sorensen JS, Leboeuf-Yde C, Modic changes and their associations with clinical findings,. European Spine Journal. 2006;15(9): 1312–1319. DOI: 10.1007/s00586-006-0185-x

Herlin C et al. Modic changes—Their associations with low back pain and activity limitation: A systematic literature review and meta-analysis. PLoS One. 2018;13(8):e0200677. DOI: 10.1371/journal.pone.0200677

Weiner BK et al. Endplate changes following discectomy: natural history and associations between imaging and clinical data. European Spine Journal. 2015;24 (11):2449–2457. DOI: 10.1007/s00586-014-3734-8

Rahme R et al. What happens to Modic changes following lumbar discectomy? Analysis of a cohort of 41 patients with a 3- to 5-year follow-up period, J Neurosurg Spine. 2010;13(5):562–567. DOI: 10.3171/2010.5.SPINE09818

Barth M, Diepers M, Weiss C, Thomé C. Two-Year Outcome After Lumbar Microdiscectomy Versus Microscopic Sequestrectomy, Spine (Phila Pa 1976). 2008;33(3):273–279. DOI: 10.1097/BRS.0b013e31816201a6

Gelalis ID et al. Clinical outcomes after lumbar spine microdiscectomy: A 5-year follow-up prospective study in 100 patients, European Journal of Orthopaedic Surgery & Traumatology. 2019;29(2):321–327. DOI: 10.1007/s00590-018-2359-8

Barth M, Fontana J, Thomé C, Bouma GJ, Schmieder K. “Occurrence of discal and non-discal changes after sequestrectomy alone versus sequestrectomy and implantation of an anulus closure device,”. Journal of Clinical Neuroscience. 2016;34: 288–293. DOI: 10.1016/j.jocn.2016.09.013

Mahmoudkhani M, Abrishamkar S, Aminmansour B, Jafari S, Mahabadi A. “Does disk space degeneration according to Los Angeles and Modic scales have relation with recurrent disk herniation?,. Adv Biomed Res. 2014;3(1):220. DOI: 10.4103/2277-9175.145125

Ross JS, Modic MT, Masaryk TJ, Hueftle MG. The postoperative lumbar spine. Semin Roentgenol. 1988;23(2):125–136. DOI: 10.1016/S0037-198X(88)80009-9

RZ, MT M, Jeffrey S, Ross. The Postoperative Lumbar Spine: Enhanced MR Evaluation of the Intervertebral Disk. AJNR Am J Neuroradiol. 1996;17:323-331.

Bostelmann R, Petridis A, Fischer K, Vajkoczy P, Bostelmann T, Barth M, New insights into the natural course and clinical relevance of Modic changes over 2 years following lumbar limited discectomy: analysis of prospective collected data, European Spine Journal. 2019;28(11): 2551–2561. DOI: 10.1007/s00586-019-05988-1

Vital JM et al. Course of Modic 1 Six Months After Lumbar Posterior Osteosynthesis, Spine (Phila Pa 1976), 2003;28(7):715–720. DOI: 10.1097/01.BRS.0000051924.3956

31

Ohtori S et al. Change in Modic Type 1 and 2 Signals After Posterolateral Fusion Surgery, Spine (Phila Pa 1976). 2010;35 (12):1231–1235, DOI: 10.1097/BRS.0b013e3181bde562

Farrokhi MR, Yadollahikhales G, Gholami M, Mousavi SR, Mesbahi AR, Asadi-Pooya AA, “Clinical outcomes of posterolateral fusion vs. Posterior lumbar interbody fusion in patients with lumbar spinal stenosis and degenerative instability., Pain Physician. 2018;21(4):383–406.

Mu X, Kim SW, Uhl E, Schöller K, “The effects of lumbar fusion and non-fusion surgery on the development of Modic changes, J Orthop Surg Res. 2022;17(1): 89. DOI: 10.1186/s13018-022-02971-3

Ross JS, Masaryk TJ, Modic MT, Bohlman H, Delamater R, Wilber G. Lumbar spine: postoperative assessment with surface-coil MR imaging., Radiology. 1987;164(3): 851–860. DOI: 10.1148/radiology.164.3.3615887

Akazawa T et al. Modic Changes and Disc Degeneration of Nonfused Segments 27 to 45 Years After Harrington Instrumentation for Adolescent Idiopathic Scoliosis, Spine (Phila Pa 1976), 2018;43(8):556–561. DOI: 10.1097/BRS.0000000000002362

Kelly DM, McCarthy RE, McCullough FL, Kelly HR, Long-term Outcomes of Anterior Spinal Fusion With Instrumentation for Thoracolumbar and Lumbar Curves in Adolescent Idiopathic Scoliosis, Spine (Phila Pa 1976). 2010;35(2):194–198. DOI: 10.1097/BRS.0b013e3181bc948e