title: Reverse transformation of Modic type 2 changes to Modic type 1 changes during sustained chronic low-back pain severity. Report of two cases and review of the literature.
abstract: Modic Type 2 (MT2) neuroimaging changes are considered stable or invariant over time and relatively quiescent, whereas Modic Type 1 (MT1) changes are considered unstable and more symptomatic. The authors report two cases in which MT2 changes were symptomatic and evidently unstable, and in which chronic low-back pain severity remained unaltered despite a MT2-MT1 reverse transformation. Two women (41 and 48 years old) both presented with chronic low-back pain. Magnetic resonance (MR) images demonstrated degenerating discs at L5-S1 associated with well-established MT2 changes in adjacent vertebrae. Repeated MR imaging in these two patients after 11 months and 7 years, respectively, revealed reverse transformation of the MT2 changes into more florid MT1 changes, despite unaltered chronic low-back pain severity. Following anterior discectomy and disc arthroplasty, immediate abolition of chronic low-back pain was achieved in both patients and sustained at 3-year follow up. Modic Type 2 changes are therefore neither as stable nor as quiescent as originally believed. Each type can change, with equal symptom-generating capacity. More representative imaging-pathological correlates are required to determine the precise nature of MT changes.
authors.affiliation: Department of Spinal Surgery, University Hospital of North Tees, United Kingdom. l.a.g.marshman@btinternet.com
authors.forename: Laurence A G
authors.initials: LA
authors.lastname: Marshman
authors.forename: Matthew
authors.initials: M
authors.lastname: Trewhella
authors.forename: Tai
authors.initials: T
authors.lastname: Friesem
authors.forename: Chandra K
authors.initials: CK
authors.lastname: Bhatia
authors.forename: Manoj
authors.initials: M
authors.lastname: Krishna
mesh_terms: D000328:Adult; D002908:Chronic Disease; D017586:Diskectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007403:Intervertebral Disc; D017116:Low Back Pain / Q000209:etiology* / Q000503:physiopathology*; D008159:Lumbar Vertebrae / Q000601:surgery; D008875:Middle Aged; D012447:Sacrum / Q000601:surgery; D012720:Severity of Illness Index; D013122:Spinal Diseases / Q000150:complications* / Q000601:surgery