Are Modic changes in patients with chronic low back pain indicative of a worse clinical course? 10 years of follow-up

Abstract

Objective: Establish the long-term (10 years) predictive value of Modic changes in the course of lumbar pain and the need for surgical treatment.

Material and method: Observational longitudinal prospective cohort study. Comparison of progression at 10 years of 2 groups of patients with chronic lumbar pain: group A with Modic changes in MRI and group B with no Modic changes.

Exclusion criteria: neoplasia, inflammatory or infectious diseases, or previous surgery. Assessment was done with the aid of the VAS for low lumbar and radicular pain and the Oswestry Disability Questionnaire. The need for surgical or medical treatment and occupational disability during the study period was analyzed. For the statistical analyses, the Mann-Whitney U test and logistic regression were applied.

Results: Seventy patients, 24 male and 46 female, with a mean age of 56.5 years (35 in each group) were included in the study. No statistically significant differences in the intensity of lumbar pain, degree of impairment, or need for medical or surgical treatment (P>.05) were found in patients with Modic changes types 1, 2, or 3 between the baseline assessment and 10 years after. No statistically significant differences between patients with/without changes in Modic at 10 years of follow-up (P>.05) were determined.

Conclusions: There is no relationship between Modic changes in MRI and greater intensity of lumbar pain or need for medical or surgical treatment at 10 years of follow-up. Modic changes cannot be considered a sign of bad prognosis by themselves, or an indication for surgery.

Keywords: Cambios Modic; Dolor; Low back pain; Lumbar; Magnetic resonance imaging; Modic changes; Resonancia magnética.