Biomechanical Stress and Active Discopathy Theories in Low Back Pain (LBP)

Biomechanical stress and Modic 1

A study 1, in the European Spine Journal, set out to uncover some theories related to low back pain (LBP) and biomechanical stress. It concluded that using weight-bearing MRI scans offer a valuable complement to standard sequences due to them presenting the radiologist with additional (and beneficial) diagnostic information about low back pain.

The Context

For many individuals out there, low back pain (LBP) caused by the degenerative disc disease of the spine is a leading reason for chronic disability and morbidity. Although there is a trend to avoid using this language with patients because of the mood it may create about their own spines. The preferred technique to evaluate a spine’s degenerative changes is an MRI because of its ability to detect water content in the discs. According to recent studies, the MRI signal changes in vertebral endplates, particularly the Modic changes (MC) type I, have been deemed a potential specific cause of LBP. More research is required to understand MC’s exact pathophysiology as the relationship between endplates, disc degeneration, and bone marrow is yet to be quantified.

What did this Study do?

The study’s objective was to evaluate the relationship between endplate modic changes type 1, degenerative disc, and pain level during a lumbar spine’s upright weight-bearing MRI scan. The study used patients with non-specific LBP, in other words, without an exact diagnosis.

The underlying hypothesis of the study was that loading could serve a role in the presentation of symptoms of LBP and Modic Type 1 changes.

What was Used?

The study evaluated 38 patients (20 females and 18 males) that had a general lower back pain diagnosis (non-specific LBP) as well as MRI evidence of Modic Type 1 vertebral changes. The age range of the participants was 27 to 69 years. An MRI unit was used to evaluate patients in a standard and upright weight-bearing position. The study compared the type 1 modic endplate  extend, intervertebral disc height at the involved level, as well as the degree of degeneration at the same intervertebral disc.

A visual analog scale questionnaire was used to assess pain. MedCalc was used for statistical analysis.

The Results

Compared to the supine position, a total of 26 participants showed an increase in the area of Modic 1 changes in the upright position. A reduction in the disc height was also observed in the upright position. A moderate negative correlation was analyzed between the area of Modic I changes and intervertebral disc height. Furthermore, a weak positive correlation was seen between Pfirrmann grade and an increase in the area of Modic type 1 changes.

The clinical evaluation showed that 30 patients reported their LBP worsening in an upright position. A significant correlation was seen between an increase in the Modic Type 1 changes and an increase in VAS values (in the upright position).

What Does It Mean?

The study showed the modifications of Modic 1 changes under loading while offering evidence (through MRI) of increased Modic changes area extent in the upright position. The results also displayed a correlation between an increase in pain and as Modic type 1 increases. It was concluded that upright scans under physiological load may offer a valid complement to standard sequences by offering more diagnostic information for treating pain because of “active discopathy” in the presence of Modic Type 1 changes.

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