title: Association between changes in lumbar Modic changes and low back symptoms over a two-year period.
abstract: BACKGROUND
  The association of Modic changes (MC) with low back pain (LBP) is unclear. The purpose of our study was to investigate the associations between the extent of Type 1 (M1) and Type 2 (M2) MC and low back symptoms over a two-year period.
  
  
  METHODS
  The subjects (n = 64, mean age 43.8 y; 55 [86%] women) were consecutive chronic LBP patients who had M1 or mixed M1/M2 on lumbar spine magnetic resonance imaging (MRI). Size and type of MC on sagittal lumbar MRI and clinical data regarding low back symptoms were recorded at baseline and two-year follow-up. The size (%) of each MC in relation to vertebral size was estimated from sagittal slices (midsagittal and left and right quarter), while proportions of M1 and M2 within the MC were evaluated from three separate slices covering the MC. The extent (%) of M1 and M2 was calculated as a product of the size of MC and the proportions of M1 and M2 within the MC, respectively. Changes in the extent of M1 and M2 were analysed for associations with changes in LBP intensity and the Oswestry disability index (ODI), using linear regression analysis.
  
  
  RESULTS
  At baseline, the mean LBP intensity was 6.5 and the mean ODI was 33%. During follow-up, LBP intensity increased in 15 patients and decreased in 41, while ODI increased in 19 patients and decreased in 44. In univariate analyses, change in the extent of M1 associated significantly positively with changes in LBP intensity and ODI (beta 0.26, p = 0.036 and beta 0.30, p = 0.017; respectively), whereas the change in the extent of M2 did not associate with changes in LBP intensity and ODI (beta -0.24, p = 0.054 and beta -0.13, p = 0.306; respectively). After adjustment for age, gender, and size of MC at baseline, change in the extent of M1 remained significantly positively associated with change in ODI (beta 0.53, p = 0.003).
  
  
  CONCLUSIONS
  Change in the extent of M1 associated positively with changes in low back symptoms.
authors.affiliation: Department of Diagnostic Radiology, Institute of Diagnostics, Oulu University Hospital, Oulu, Finland. jyri.jarvinen@ppshp.fi.
authors.forename: Jyri
authors.initials: J
authors.lastname: Järvinen
authors.affiliation: Center for Life Course Epidemiology and Systems Medicine, Faculty of Medicine, University of Oulu, Oulu, Finland. jaro.karppinen@ttl.fi.|Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland. jaro.karppinen@ttl.fi.|Finnish Institute of Occupational Health, Health and Work Ability, and Disability Prevention Centre, Oulu, Finland. jaro.karppinen@ttl.fi.
authors.forename: Jaro
authors.initials: J
authors.lastname: Karppinen
authors.affiliation: Department of Diagnostic Radiology, Institute of Diagnostics, Oulu University Hospital, Oulu, Finland. jaakko.niinimaki@oulu.fi.|Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland. jaakko.niinimaki@oulu.fi.
authors.forename: Jaakko
authors.initials: J
authors.lastname: Niinimäki
authors.affiliation: Department of Diagnostic Radiology, Institute of Diagnostics, Oulu University Hospital, Oulu, Finland. marianne.haapea@oulu.fi.
authors.forename: Marianne
authors.initials: M
authors.lastname: Haapea
authors.affiliation: Department of Physical and Rehabilitation Medicine, Institute of Clinical Sciences, University of Helsinki, Helsinki, Finland. mats.gronblad@hus.fi.
authors.forename: Mats
authors.initials: M
authors.lastname: Grönblad
authors.affiliation: University of Helsinki and HUS Imaging Center, Helsinki University Central Hospital, Helsinki, Finland. katariina.luoma@kolumbus.fi.
authors.forename: Katariina
authors.initials: K
authors.lastname: Luoma
authors.affiliation: Department of Physical and Rehabilitation Medicine, Institute of Clinical Sciences, University of Helsinki, Helsinki, Finland. eeva.rinne@hus.fi.
authors.forename: Eeva
authors.initials: E
authors.lastname: Rinne
mesh_terms: D000328:Adult; D001853:Bone Marrow / Q000473:pathology*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000453:epidemiology* / Q000503:physiopathology*; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index