title: Association of accelerated switch from vertebral end-plate Modic I to Modic 0 signal changes with clinical benefit of intradiscal corticosteroid injection for chronic low back pain.
abstract: Modic I vertebral end-plate signal changes detected by magnetic resonance imaging (MRI) are associated with chronic low back pain. Typically, Modic I signal changes in untreated patients switch to non-Modic I signal changes within 3 years, which reflect spontaneous healing. Recent findings suggest that Modic I signal changes may be related to local inflammatory changes, providing a rationale for treatment with intradiscal injections of antiinflammatory drugs. In the present report, we describe a 31-year-old man with 1-year history of chronic low back pain associated with vertebral end-plate Modic I signal changes, who received 1 intradiscal corticosteroid injection in L5-S1. Local treatment led to rapid pain relief and was associated with an accelerated switch from Modic I to Modic 0 signal changes, as seen on lumbar MRI at 1-month followup. This is the first report of an effective local treatment for both the symptoms and the structural changes of chronic low back pain that are associated with Modic I signal changes. Additionally, this case reinforces the hypothesis that local inflammation has a pathogenic role.
authors.affiliation: Paris Descartes University, Rehabilitation Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris and INSERM, Institut Fédératif de Recherche sur le Handicap, Paris, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Nguyen
authors.forename: Marc
authors.initials: M
authors.lastname: Bénichou
authors.forename: Michel
authors.initials: M
authors.lastname: Revel
authors.forename: Serge
authors.initials: S
authors.lastname: Poiraudeau
authors.forename: François
authors.initials: F
authors.lastname: Rannou
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D002908:Chronic Disease; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology*; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology*; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011859:Radiography; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones