Clinical Consultation
From: William J Owens Jr DC DAAMLP
Understanding the difference between and ACUTE or CHRONIC injury to the spine is a critical part of proper spine care. One of the ways to do that is to use the Modic scale to determine how long a reactive process has been present in the spine.
Here is a very brief reference sheet to help you. REMINDER – you need to review BOTH the T1 and the T2 weighted images to determine the Modic criteria.
Modic type endplate changes represent a classification for vertebral body end-plate MRI signal, first described in 1988 1. It is widely recognised by radiologists and clinicians and is a useful shorthand for reporting MRIs of the spine.
Recently Modic type I has received renewed attention due to the possibility of it representing low grade indolent infection. It is thus discussed separately here.
- Modic type I – typically ranges from instant (d/t trauma) to 18 months
- T1: low signal
- T2: high signal
- represents bone marrow oedema and inflammation
- T1+C: enhancement
- Modic type II – typically ranges from 18-24 months
- T1: high signal
- T2: iso to high signal
- represents normal red haemopoietic bone marrow conversioninto yellow fatty marrowas a result of marrow ischaemia
- Modic type III – typically greater than 24 months
- T1: low signal
- T2: low signal
- representssubchondral bony sclerosis
Diagnosing modic changes[edit]
- In Modic type 1 there is vascular development in the vertebral body, with findings of inflammation and edema, but no trabecular damage or marrow changes.
- In Modic type 2 there are changes in bone marrow, with fatty replacement of formerly red, cellular marrow normally seen there. With Modic type 2 changes the marrow is substituted by visceral fat, the same kind of fat we have on our hips and bellies.
- Modic Changes type 3 are less common, with fractures of the trabecular bone, along with trabecular shortening and widening.
Bibliography
- Modic MT, Steinberg PM, Ross JS, et al. (1988). “Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging”. Radiology. 166 (1): 193–9. PMID 3336678. doi:10.1148/radiology.166.1.3336678.
- Modic MT, Masaryk TJ, Ross JS, Carter JR (1988). “Imaging af degererative disk disease”. Radiology. 168: 177–86. doi:10.1148/radiology.168.1.3289089.
- Albert HB (2008). “Modic changes, possible causes and relation to low back pain.”.”. Med Hypotheses. 70 (2): 361–8. PMID 17624684. doi:10.1016/j.mehy.2007.05.014.
- Albert HB (Jul 2007). “Modic changes following lumbar disc herniation.”.”. Eur Spine J. 16 (7): 977–82. PMC 2219661
. PMID 17334791. doi:10.1007/s00586-007-0336-8. - https://ama.com.au/ausmed/back-pain-breakthrough-crippled-doubt
https://en.wikipedia.org/wiki/Modic_changes
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