Modic changes associated with greater pain relief following anesthetization of the adjacent lumbar intervertebral disc: A retrospective study of chronic low back pain patients

Tero Korhonen; Jyri Järvinen; Juha Pesälä; Marianne Haapea; Jaakko Niinimäki

doi:10.1016/j.ejrad.2022.110589

Modic changes associated with greater pain relief following anesthetization of the adjacent lumbar intervertebral disc: A retrospective study of chronic low back pain patients

Eur J Radiol. 2022 Dec:157:110589. doi: 10.1016/j.ejrad.2022.110589. Epub 2022 Nov 1.

Authors

Tero Korhonen¹, Jyri Järvinen², Juha Pesälä³, Marianne Haapea⁴, Jaakko Niinimäki⁵

Affiliations

¹ Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, PO Box 5000, 90014 Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PO Box 8000, 90014 Oulu, Finland. Electronic address: Tero.Korhonen@student.oulu.fi.
² Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, PO Box 5000, 90014 Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PO Box 8000, 90014 Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, PO Box 50, 90029 OYS, Oulu, Finland.
³ Department of Orthopaedics and Traumatology, Oulu University Hospital, PO Box 10, 90029 OYS, Oulu, Finland.
⁴ Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PO Box 8000, 90014 Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, PO Box 50, 90029 OYS, Oulu, Finland.
⁵ Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, PO Box 5000, 90014 Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PO Box 8000, 90014 Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, PO Box 50, 90029 OYS, Oulu, Finland. Electronic address: Jaakko.Niinimaki@oulu.fi.

PMID: 36356461
DOI: 10.1016/j.ejrad.2022.110589

Abstract

Purpose: To assess the correlation between the degree of pain relief following discoblock and the presence and type of adjacent Modic changes (MC).

Method: We retrospectively analyzed chronic low back pain (LBP) patients whose pain was suspected to originate from a specific lumbar intervertebral disc (IVD) based on a spine orthopedist's clinical evaluation and magnetic resonance imaging (MRI). Thus, patients were selected to undergo discoblock. We calculated the degree of pain relief following discoblock on Numerical Rating Scale (ΔNRS) and analyzed the MRIs on the basis of MC presence and type on the lumbar spinal segment in question. We assessed the differences in ΔNRS between the groups with absent and present MC and the groups of MC subtypes.

Results: Forty-five patients were included in the present study, all of whom underwent discoblock at a single level. The total MC prevalence was 77.8 % (35 patients); pure or dominant MC type 1 (MC1 group) 35.6 % (16 patients); and pure or dominant MC type 2 (MC2 group) 42.2 % (19 patients). ΔNRS was significantly greater in the group with MC compared to the group without MC (median ΔNRS -5.0 vs -2.5, respectively, P = 0.043). In pairwise comparisons, a significant difference in ΔNRS was found between the MC1 group and the group without MC (median ΔNRS -5.0 vs -2.5, respectively, P = 0.012).

Conclusions: We propose that MC type 1 are associated with lumbar spinal pain, and that the pain arises at least partly from the adjacent IVD or endplate.

Keywords: Chronic; Disc degeneration; Discoblock; Discogenic; Low back pain; Modic changes.

MeSH terms

Humans
Intervertebral Disc Degeneration* / complications
Intervertebral Disc Degeneration* / diagnostic imaging
Intervertebral Disc* / diagnostic imaging
Intervertebral Disc* / pathology
Low Back Pain* / diagnostic imaging
Low Back Pain* / etiology
Lumbar Vertebrae / diagnostic imaging
Lumbar Vertebrae / pathology
Lumbosacral Region
Magnetic Resonance Imaging
Retrospective Studies