title: Type 1 Modic changes was a significant risk factor for 1-year outcome in sick-listed low back pain patients: a nested cohort study using magnetic resonance imaging of the lumbar spine.
abstract: BACKGROUND
  It is not clear whether Modic changes (MC) is associated with low back pain (LBP) outcome.
  
  
  OBJECTIVE
  To study associations between baseline degenerative manifestations and outcome in sick-listed LBP patients.
  
  
  METHODS
  Prospective nested cohort study based on a randomized controlled trial.
  
  
  METHODS
  Out of 325 sick-listed LBP patients, 141 were consecutively examined by magnetic resonance imaging (MRI) and included and 140 completed the study.
  
  
  METHODS
  Degenerative manifestations of the lumbar spine were quantified; associations were studied in relation to the three primary outcomes: change of back+leg pain, change of function as measured by Roland-Morris questionnaire, and 1-year unsuccessful return to work (U-RTW).
  
  
  METHODS
  By using a previously validated MRI protocol, a specialist in radiology, who had no access to clinical data, described the images. Associations were studied by linear and logistic regression with adjustment for previously identified prognostic factors for 1-year pain and function and for U-RTW.
  
  
  RESULTS
  Clinically, 43% of the patients had radiculopathy. Degenerative changes were prevalent with altered disc contours in 84%, high-intensity zones in 70%, and nerve root touch or impingement in 63% of the patients. MC was identified in 60% of the patients, 18% with Type 1 changes and 42% with Type 2 changes, Type 1 including both Type 1 and Type 1 in combination with Type 2. Patients with Type 1 changes reported more back pain and did not improve in pain or disability. They increased to include 30% of the patients with U-RTW at 1 year. Patients with Type 2 changes did not differ significantly from patients without MC but differed significantly from patients with Type 1 changes in all three outcomes. Other degenerative manifestations were not significantly associated with any of the three outcomes.
  
  
  CONCLUSIONS
  The only degenerative manifestation negatively associated with outcome was Type 1 MC that affected 18% of the cohort at baseline and implied an increased risk for no improvement in pain and function and for U-RTW, even after adjustment for other prognostic factors.
authors.affiliation: The Spine Center, Diagnostic Center, Silkeborg Regional Hospital, Falkevej 1-3, 8600 Silkeborg, Denmark. Electronic address: olejesen@rm.dk.
authors.forename: Ole Kudsk
authors.initials: OK
authors.lastname: Jensen
authors.affiliation: Section of Clinical Social Medicine and Rehabilitation, Institute of Public Health, University of Aarhus, P.P. Ørumsgade 11, 8000 Aarhus C, Denmark.
authors.forename: Claus Vinther
authors.initials: CV
authors.lastname: Nielsen
authors.affiliation: Associated to Research Department, Spine Centre of Southern Denmark, Lillebaelt Hospital, Østre Hougvej 55, 5500 Middelfart, Denmark.
authors.forename: Joan Solgaard
authors.initials: JS
authors.lastname: Sørensen
authors.affiliation: Department of Rheumatology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark.
authors.forename: Kristian
authors.initials: K
authors.lastname: Stengaard-Pedersen
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000209:etiology / Q000473:pathology*; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011379:Prognosis; D011446:Prospective Studies; D011843:Radiculopathy / Q000150:complications / Q000473:pathology*; D062707:Return to Work; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Disc herniation; Low back pain; Modic changes; Prognosis; Return to work; Sick listing