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Spine
Diagnosis
Degenerative Diseases and Arthritides
Degenerative Diseases
Degenerative Endplate Changes
Degenerative Endplate Changes
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Top Differential Diagnoses

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Vertebral endplate change, Modic changes
            • Type I, II, III endplate change

          • Definitions

            • MR signal abnormalities involving vertebral body endplates related to degenerative disc disease
              • Type I: Hypointense on T1WI, hyperintense on T2WI
              • Type II: Hyperintense on T1WI, isointense on T2WI
              • Type III: Hypointense on T1WI and T2WI

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Chen Y et al: Distribution of Modic changes in patients with low back pain and its related factors. Eur J Med Res. 24(1):34, 2019
                                            2. Dudli S et al: Pathobiology of Modic changes. Eur Spine J. 25(11):3723-34, 2016
                                            3. Albert HB et al: Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy. Eur Spine J. 22(4):697-707, 2013
                                            4. Luoma K et al: Relationship of Modic type 1 change with disc degeneration: a prospective MRI study. Skeletal Radiol. 38(3):237-44, 2009
                                            5. Thompson KJ et al: Modic changes on MR images as studied with provocative diskography: clinical relevance--a retrospective study of 2457 disks. Radiology. 250(3):849-55, 2009
                                            6. Jensen TS et al: Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J. 17(11):1407-22, 2008
                                            7. Rahme R et al: The modic vertebral endplate and marrow changes: pathologic significance and relation to low back pain and segmental instability of the lumbar spine. AJNR Am J Neuroradiol. 29(5):838-42, 2008
                                            8. Zhang YH et al: Modic changes: a systematic review of the literature. Eur Spine J. 17(10):1289-99, 2008
                                            9. Modic MT et al: Lumbar degenerative disk disease. Radiology. 245(1):43-61, 2007
                                            10. Senegas J: Mechanical supplementation by non-rigid fixation in degenerative intervertebral lumbar segments: the Wallis system. Eur Spine J. 11 Suppl 2: S164-9, 2002
                                            11. Stumpe KD et al: FDG positron emission tomography for differentiation of degenerative and infectious endplate abnormalities in the lumbar spine detected on MR imaging. AJR Am J Roentgenol. 179(5): 1151-7, 2002
                                            12. Weishaupt D et al: Painful lumbar disk derangement: relevance of endplate abnormalities at MR imaging. Radiology. 218(2):420-7, 2001
                                            13. Sandhu HS et al: Association between findings of provocative discography and vertebral endplate signal changes as seen on MRI. J Spinal Disord. 13(5): 438-43, 2000
                                            14. Van Goethem JW et al: The value of MRI in the diagnosis of postoperative spondylodiscitis. Neuroradiology. 42(8): 580-5, 2000
                                            15. Braithwaite I et al: Vertebral end-plate (Modic) changes on lumbar spine MRI: correlation with pain reproduction at lumbar discography. Eur Spine J. 7(5):363-8, 1998
                                            16. Ito M et al: Predictive signs of discogenic lumbar pain on magnetic resonance imaging with discography correlation. Spine. 23(11): 1252-8; discussion 1259-60, 1998
                                            17. Ross JS et al: The postoperative lumbar spine: enhanced MR evaluation of the intervertebral disk. AJNR Am J Neuroradiol. 17(2): 323-31, 1996
                                            18. Modic MT et al: Contrast-enhanced MR imaging in acute lumbar radiculopathy: a pilot study of the natural history. Radiology. 195(2): 429-35, 1995
                                            19. Ulmer JL et al: Lumbar spondylolysis: reactive marrow changes seen in adjacent pedicles on MR images. AJR Am J Roentgenol. 164(2): 429-33, 1995
                                            20. Ross JS et al: Current assessment of spinal degenerative disease with magnetic resonance imaging. Clin Orthop. (279): 68-81, 1992
                                            21. Ross JS et al: Assessment of extradural degenerative disease with Gd-DTPA-enhanced MR imaging: correlation with surgical and pathologic findings. AJNR Am J Neuroradiol. 10(6):1243-9, 1989
                                            22. Hueftle MG et al: Lumbar spine: postoperative MR imaging with Gd-DTPA. Radiology. 167(3):817-24, 1988
                                            23. Masaryk TJ et al: High-resolution MR imaging of sequestered lumbar intervertebral disks. AJR Am J Roentgenol. 150(5):1155-62, 1988
                                            24. Modic MT et al: Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 166(1 Pt 1):193-9, 1988
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Synonyms

                                                      • Vertebral endplate change, Modic changes
                                                      • Type I, II, III endplate change

                                                    • Definitions

                                                      • MR signal abnormalities involving vertebral body endplates related to degenerative disc disease
                                                        • Type I: Hypointense on T1WI, hyperintense on T2WI
                                                        • Type II: Hyperintense on T1WI, isointense on T2WI
                                                        • Type III: Hypointense on T1WI and T2WI

                                                    IMAGING

                                                    • General Features

                                                      • Radiographic Findings

                                                        • CT Findings

                                                          • MR Findings

                                                            • Nuclear Medicine Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Chen Y et al: Distribution of Modic changes in patients with low back pain and its related factors. Eur J Med Res. 24(1):34, 2019
                                                                                      2. Dudli S et al: Pathobiology of Modic changes. Eur Spine J. 25(11):3723-34, 2016
                                                                                      3. Albert HB et al: Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy. Eur Spine J. 22(4):697-707, 2013
                                                                                      4. Luoma K et al: Relationship of Modic type 1 change with disc degeneration: a prospective MRI study. Skeletal Radiol. 38(3):237-44, 2009
                                                                                      5. Thompson KJ et al: Modic changes on MR images as studied with provocative diskography: clinical relevance--a retrospective study of 2457 disks. Radiology. 250(3):849-55, 2009
                                                                                      6. Jensen TS et al: Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J. 17(11):1407-22, 2008
                                                                                      7. Rahme R et al: The modic vertebral endplate and marrow changes: pathologic significance and relation to low back pain and segmental instability of the lumbar spine. AJNR Am J Neuroradiol. 29(5):838-42, 2008
                                                                                      8. Zhang YH et al: Modic changes: a systematic review of the literature. Eur Spine J. 17(10):1289-99, 2008
                                                                                      9. Modic MT et al: Lumbar degenerative disk disease. Radiology. 245(1):43-61, 2007
                                                                                      10. Senegas J: Mechanical supplementation by non-rigid fixation in degenerative intervertebral lumbar segments: the Wallis system. Eur Spine J. 11 Suppl 2: S164-9, 2002
                                                                                      11. Stumpe KD et al: FDG positron emission tomography for differentiation of degenerative and infectious endplate abnormalities in the lumbar spine detected on MR imaging. AJR Am J Roentgenol. 179(5): 1151-7, 2002
                                                                                      12. Weishaupt D et al: Painful lumbar disk derangement: relevance of endplate abnormalities at MR imaging. Radiology. 218(2):420-7, 2001
                                                                                      13. Sandhu HS et al: Association between findings of provocative discography and vertebral endplate signal changes as seen on MRI. J Spinal Disord. 13(5): 438-43, 2000
                                                                                      14. Van Goethem JW et al: The value of MRI in the diagnosis of postoperative spondylodiscitis. Neuroradiology. 42(8): 580-5, 2000
                                                                                      15. Braithwaite I et al: Vertebral end-plate (Modic) changes on lumbar spine MRI: correlation with pain reproduction at lumbar discography. Eur Spine J. 7(5):363-8, 1998
                                                                                      16. Ito M et al: Predictive signs of discogenic lumbar pain on magnetic resonance imaging with discography correlation. Spine. 23(11): 1252-8; discussion 1259-60, 1998
                                                                                      17. Ross JS et al: The postoperative lumbar spine: enhanced MR evaluation of the intervertebral disk. AJNR Am J Neuroradiol. 17(2): 323-31, 1996
                                                                                      18. Modic MT et al: Contrast-enhanced MR imaging in acute lumbar radiculopathy: a pilot study of the natural history. Radiology. 195(2): 429-35, 1995
                                                                                      19. Ulmer JL et al: Lumbar spondylolysis: reactive marrow changes seen in adjacent pedicles on MR images. AJR Am J Roentgenol. 164(2): 429-33, 1995
                                                                                      20. Ross JS et al: Current assessment of spinal degenerative disease with magnetic resonance imaging. Clin Orthop. (279): 68-81, 1992
                                                                                      21. Ross JS et al: Assessment of extradural degenerative disease with Gd-DTPA-enhanced MR imaging: correlation with surgical and pathologic findings. AJNR Am J Neuroradiol. 10(6):1243-9, 1989
                                                                                      22. Hueftle MG et al: Lumbar spine: postoperative MR imaging with Gd-DTPA. Radiology. 167(3):817-24, 1988
                                                                                      23. Masaryk TJ et al: High-resolution MR imaging of sequestered lumbar intervertebral disks. AJR Am J Roentgenol. 150(5):1155-62, 1988
                                                                                      24. Modic MT et al: Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 166(1 Pt 1):193-9, 1988