Modic (endplate) changes in the lumbar spine: bone micro-architecture and remodelling

Egon Perilli, Ian Parkinson, Le-Hoa Truong, Kuan Chong, Nicola Fazzalari, Orso Osti

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    Abstract

    Purpose: In the literature, inter-vertebral MRI signal intensity changes (Modic changes) were associated with corresponding histological observations on endplate biopsies. However, tissue-level studies were limited. No quantitative histomorphometric study on bone biopsies has yet been conducted for Modic changes. The aim of this study was to characterise the bone micro-architectural parameters and bone remodelling indices associated with Modic changes. Methods: Forty patients suffering from disabling low back pain, undergoing elective spinal surgery, and exhibiting Modic changes on MRI (Modic 1, n = 9; Modic 2, n = 25; Modic 3, n = 6), had a transpedicular vertebral body biopsy taken of subchondral bone. Biopsies were first examined by micro-CT, for 3D morphometric analysis of bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular separation, trabecular number, and structure model index. Then, samples underwent histological analysis, for determination of bone remodelling indices: osteoid surface to bone surface ratio (OS/BS), eroded surface to bone surface (ES/BS) and osteoid surface to eroded surface ratio (OS/ES). Results: Micro-CT analysis revealed significantly higher BV/TV (up to 70 % increase, p < 0.01) and Tb.Th (up to +57 %, p < 0.01) in Modic 3 biopsies, compared to Modic 1 and 2. Histological analysis showed significantly lower OS/BS in Modic 2 biopsies (more than 28 % decrease, p < 0.05) compared to 1 and 3. ES/BS progressively decreased from Modic 1 to 2 to 3, whereas OS/ES progressively increased with significantly higher values in Modic 3 (up to 159 % increase, p < 0.05) than in Modic 1 and 2. Conclusions: Significant differences were found in bone micro-architectural parameters and remodelling indices among Modic types. Modic 1 biopsies had evidence of highest bone turnover, possibly due to an inflammatory process; Modic 2 biopsies were consistent with a reduced bone formation/remodelling stage; Modic 3 biopsies suggested a more stable sclerotic phase, with significantly increased BV/TV and Tb.Th compared to Modic 1 and 2, linked to increased bone formation and reduced resorption.

    Original languageEnglish
    Pages (from-to)1926-1934
    Number of pages9
    JournalEUROPEAN SPINE JOURNAL
    Volume24
    Issue number9
    DOIs
    Publication statusPublished - 28 Sep 2015

    Keywords

    • Bone remodelling
    • Histology
    • Micro-architecture
    • Micro-computed tomography
    • Modic changes
    • Vertebra

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