TY - JOUR
T1 - Measuring and reporting of vertebral endplate bone marrow lesions as seen on MRI (Modic changes)
T2 - recommendations from the ISSLS Degenerative Spinal Phenotypes Group
AU - for the ISSLS Degenerative Spinal Phenotypes Group
AU - Fields, Aaron J.
AU - Battié, Michele C.
AU - Herzog, Richard J.
AU - Jarvik, Jeffrey G.
AU - Krug, Roland
AU - Link, Thomas M.
AU - Lotz, Jeffrey C.
AU - O’Neill, Conor W.
AU - Sharma, Aseem
N1 - Funding Information:
The Degenerative Spinal Phenotypes Group of the International Society for the Study of the Lumbar Spine was co-chaired by Dino Samartzis, Joseph Assheur, Bradley Weiner, and Michele Batti?, with the goal of investigating and promoting common concepts, nomenclature, definitions, and core measures for degenerative spinal phenotypes to advance knowledge in the field. The imaging data accompanying this commentary were acquired with support from the National Institutes of Health, Grants R01AR070198 (AJF), R01AR063705 (JCL), and P30AR066262 (JCL). The authors acknowledge Dave Glidden, PhD, for providing biostatistics consultation.
Funding Information:
The Degenerative Spinal Phenotypes Group of the International Society for the Study of the Lumbar Spine was co-chaired by Dino Samartzis, Joseph Assheur, Bradley Weiner, and Michele Battié, with the goal of investigating and promoting common concepts, nomenclature, definitions, and core measures for degenerative spinal phenotypes to advance knowledge in the field. The imaging data accompanying this commentary were acquired with support from the National Institutes of Health, Grants R01AR070198 (AJF), R01AR063705 (JCL), and P30AR066262 (JCL). The authors acknowledge Dave Glidden, PhD, for providing biostatistics consultation.
Publisher Copyright:
© 2019, The Author(s).
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Purpose: The positive association between low back pain and MRI evidence of vertebral endplate bone marrow lesions, often called Modic changes (MC), offers the exciting prospect of diagnosing a specific phenotype of chronic low back pain (LBP). However, imprecision in the reporting of MC has introduced substantial challenges, as variations in both imaging equipment and scanning parameters can impact conspicuity of MC. This review discusses key methodological factors that impact MC classification and recommends guidelines for more consistent MC reporting that will allow for better integration of research into this LBP phenotype. Methods: Non-systematic literature review. Results: The high diagnostic specificity of MC classification for a painful level contributes to the significant association observed between MC and LBP, whereas low and variable sensitivity underlies the between- and within-study variability in observed associations. Poor sensitivity may be owing to the presence of other pain generators, to the limited MRI resolution, and to the imperfect reliability of MC classification, which lowers diagnostic sensitivity and thus influences the association between MC and LBP. Importantly, magnetic field strength and pulse sequence parameters also impact detection of MC. Advances in pulse sequences may improve reliability and prove valuable for quantifying lesion severity. Conclusions: Comparison of MC data between studies can be problematic. Various methodological factors impact detection and classification of MC, and the lack of reporting guidelines hinders interpretation and comparison of findings. Thus, it is critical to adopt imaging and reporting standards that codify acceptable methodological criteria. Graphic abstract: These slides can be retrieved under Electronic Supplementary Material. [Figure not available: see fulltext.].
AB - Purpose: The positive association between low back pain and MRI evidence of vertebral endplate bone marrow lesions, often called Modic changes (MC), offers the exciting prospect of diagnosing a specific phenotype of chronic low back pain (LBP). However, imprecision in the reporting of MC has introduced substantial challenges, as variations in both imaging equipment and scanning parameters can impact conspicuity of MC. This review discusses key methodological factors that impact MC classification and recommends guidelines for more consistent MC reporting that will allow for better integration of research into this LBP phenotype. Methods: Non-systematic literature review. Results: The high diagnostic specificity of MC classification for a painful level contributes to the significant association observed between MC and LBP, whereas low and variable sensitivity underlies the between- and within-study variability in observed associations. Poor sensitivity may be owing to the presence of other pain generators, to the limited MRI resolution, and to the imperfect reliability of MC classification, which lowers diagnostic sensitivity and thus influences the association between MC and LBP. Importantly, magnetic field strength and pulse sequence parameters also impact detection of MC. Advances in pulse sequences may improve reliability and prove valuable for quantifying lesion severity. Conclusions: Comparison of MC data between studies can be problematic. Various methodological factors impact detection and classification of MC, and the lack of reporting guidelines hinders interpretation and comparison of findings. Thus, it is critical to adopt imaging and reporting standards that codify acceptable methodological criteria. Graphic abstract: These slides can be retrieved under Electronic Supplementary Material. [Figure not available: see fulltext.].
KW - Bone marrow lesion
KW - Endplate damage
KW - Low back pain
KW - Magnetic resonance imaging
KW - Modic changes
UR - http://www.scopus.com/inward/record.url?scp=85071417226&partnerID=8YFLogxK
U2 - 10.1007/s00586-019-06119-6
DO - 10.1007/s00586-019-06119-6
M3 - Review article
C2 - 31446492
AN - SCOPUS:85071417226
VL - 28
SP - 2266
EP - 2274
JO - European Spine Journal
JF - European Spine Journal
SN - 0940-6719
IS - 10
ER -