Measuring and reporting of vertebral endplate bone marrow lesions as seen on MRI (Modic changes): recommendations from the ISSLS Degenerative Spinal Phenotypes Group

Eur Spine J. 2019 Oct;28(10):2266-2274. doi: 10.1007/s00586-019-06119-6. Epub 2019 Aug 24.


Purpose: The positive association between low back pain and MRI evidence of vertebral endplate bone marrow lesions, often called Modic changes (MC), offers the exciting prospect of diagnosing a specific phenotype of chronic low back pain (LBP). However, imprecision in the reporting of MC has introduced substantial challenges, as variations in both imaging equipment and scanning parameters can impact conspicuity of MC. This review discusses key methodological factors that impact MC classification and recommends guidelines for more consistent MC reporting that will allow for better integration of research into this LBP phenotype.

Methods: Non-systematic literature review.

Results: The high diagnostic specificity of MC classification for a painful level contributes to the significant association observed between MC and LBP, whereas low and variable sensitivity underlies the between- and within-study variability in observed associations. Poor sensitivity may be owing to the presence of other pain generators, to the limited MRI resolution, and to the imperfect reliability of MC classification, which lowers diagnostic sensitivity and thus influences the association between MC and LBP. Importantly, magnetic field strength and pulse sequence parameters also impact detection of MC. Advances in pulse sequences may improve reliability and prove valuable for quantifying lesion severity.

Conclusions: Comparison of MC data between studies can be problematic. Various methodological factors impact detection and classification of MC, and the lack of reporting guidelines hinders interpretation and comparison of findings. Thus, it is critical to adopt imaging and reporting standards that codify acceptable methodological criteria. These slides can be retrieved under Electronic Supplementary Material.

Keywords: Bone marrow lesion; Endplate damage; Low back pain; Magnetic resonance imaging; Modic changes.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Bone Marrow / diagnostic imaging*
  • Humans
  • Low Back Pain / etiology
  • Lumbar Vertebrae / diagnostic imaging*
  • Magnetic Resonance Imaging*