Modic Type 1 Vertebral Endplate Changes: Injury, Inflammation, or Infection?

AJR Am J Roentgenol. 2017 Jul;209(1):167-170. doi: 10.2214/AJR.16.17403. Epub 2017 Apr 12.


Objective: In the 29 years since the initial description of Modic type 1 vertebral endplate changes there has been ongoing debate regarding their cause. Studies have attributed Modic type 1 vertebral endplate changes to traumatic injury to the vertebral endplate, localized action of proinflammatory mediators, and more recently low-grade bacterial infection. Can we reconcile these conflicting data about the underlying cause of Modic type 1 vertebral endplate changes? Are we now in a position to conclude whether Modic type 1 vertebral endplate changes are secondary to injury, inflammation, or infection?

Conclusion: We argue that the processes are not disparate but are in fact closely linked, each potentially instigating a chain of events leading to the MRI findings of Modic type 1 vertebral endplate change. A method of delineating which process is predominantly at play in an individual patient is required so that tailored treatment options can be offered with huge potential benefit to individuals and society alike.

Keywords: Modic type 1 vertebral endplate change; low-grade infection; mechanical stress; proinflammatory mediators.

Publication types

  • Review

MeSH terms

  • Contrast Media
  • Discitis / diagnostic imaging
  • Discitis / pathology
  • Disease Progression
  • Humans
  • Inflammation
  • Intervertebral Disc / diagnostic imaging*
  • Intervertebral Disc / pathology*
  • Low Back Pain / diagnostic imaging*
  • Low Back Pain / pathology*
  • Lumbar Vertebrae / diagnostic imaging*
  • Lumbar Vertebrae / pathology*
  • Magnetic Resonance Imaging / methods*


  • Contrast Media