Eran Rotem MD, Presenter: Nothing to Disclose

Khuram Shahzad Kazmi MD, Abstract Co-Author: Nothing to Disclose

Sameer Nevile MD, Abstract Co-Author: Nothing to Disclose

Nachum Burt Stollman MD, Abstract Co-Author: Nothing to Disclose

Robert Alan Koenigsberg DO, Abstract Co-Author: Nothing to Disclose

Investigate the relationship between marrow signal changes of the endplates (Modic changes) and normal disc spaces in patients undergoing lumbar MRI for low back pain.

A retrospective review of 215 consecutive patients undergoing lumbar MRI for low back pain at our institution was performed. Each exam was reviewed by 2 radiologists. The primary inclusion criterion was the presence of degenerative vertebral endplate signal changes. Patients post discectomy, spinal infection, vertebral fracture, metastatic disease or vertebral hemangioma were excluded. A normal intervertebral disc was defined by normal height and signal on T2 weighted images without bulging or herniation. Independent sample t-test was performed to compare age and gender between the normal and abnormal disc groups. Chi-square test was performed to compare the frequency of Modic type (1-3) and levels of the discs (L1/L2-L5/S1).

38 patients were included in our study. The mean age was 61.8 years (±16). There were 19 men and 19 women. A total of 47 levels were found to have endplate signal changes. 6 (12.8%) discs were normal while 41 (87.2%) discs were abnormal. There were 11 levels with type 1 (edema) changes (23.9%). Type II (fatty) changes were found at 26 levels (56.5%) and type III (sclerotic) at 9 levels (19.6%). There was a statistically significant difference in age between normal disc group (42.7±12.8 years) and abnormal disc group (64.6±14.9 years) (p<0.001). No significant difference was found when comparing gender or specific level of the involved disc. There was a statistically significant difference in Modic type between the normal disc group {type I N=2(18.2%), type II N=0(0%) and type III N=4(44.4%)} when compared to the abnormal disc group {type I N=9(81.8%), type II N=26(100%) and type III N=5(55.6%)}(p<0.01).

Vertebral endplate signal changes can occur in the presence of a normal disc space. This was more likely to occur in younger patients and patients with type 1 and type 3 changes. Our findings suggest that either early disc degeneration not detectable on MRI can lead to endplate changes or that disc degeneration is not required to develop endplate changes. Further study is required.

To further the understanding of endplate signal changes and their relationship to disc degeneration and possibly low back pain.

Rotem, E, Kazmi, K, Nevile, S, Stollman, N, Koenigsberg, R, Marrow Signal Changes of the Vertebral Endplates in the Presence of a Normal Disc Space.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9011759.html