title: Disabling chronic low back pain with Modic type 1 MRI signal: acute reduction in pain with intradiscal corticotherapy.
abstract: OBJECTIVE
  The objective of the current study was to compare short- and long-term effect on chronic low back pain of intradiscal injection of methylprednisolone with or without presence of Modic type 1 MRI changes.
  
  
  METHODS
  Medical charts of patients receiving intradiscal injection of methylprednisolone from January 1, 1995 to December 31, 1998 were retrospectively reviewed. Clinical parameters were recorded at baseline, 24h after injection and at follow-up (12-14 months). Patients were studied in three groups: Modic I-a, if patients had Modic type 1 changes with no previous surgery or nucleolysis (n=30); Modic I-b, if patients had Modic type 1 changes at the level of previous surgery or nucleolysis (n=37); Control, if patients had no Modic type 1 changes (n=30).
  
  
  RESULTS
  Twenty-four hours after methylprednisolone injection, higher proportion of patients with self-assessed improvement was observed in Modic I-a (90%) and Modic I-b (71%) than in Control (30%). Low back pain decreased in both Modic groups. Low back pain did not vary from baseline in controls. No effect was detected in three groups, neither for radiating pain 24h after injection, nor for any outcome parameters at the latest follow-up.
  
  
  CONCLUSIONS
  We suggest that patients with disabling chronic low back pain and Modic type 1 MRI changes have specific acute response to intradiscal injection of methylprednisolone. Clinical studies are however necessary to further investigate the effectiveness and safety of such injections.
authors.affiliation: Service de rhumatologie, hôpital Lariboisière, AP-HP, université Paris-7, Paris, France. johann.beaudreuil@lrb.aphp.fr
authors.forename: J
authors.initials: J
authors.lastname: Beaudreuil
authors.forename: P
authors.initials: P
authors.lastname: Dieude
authors.forename: S
authors.initials: S
authors.lastname: Poiraudeau
authors.forename: M
authors.initials: M
authors.lastname: Revel
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D007403:Intervertebral Disc; D017116:Low Back Pain / Q000188:drug therapy*; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D012447:Sacrum
chemical_list: D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone