Modic changes in the lumbar spine: histology, risk factors, clinical presentation and treatment

The article presents a literature review on the ­Modic changes (MCs) in the vertebral endplates, which are frequently detected in patients with chronic low back pain. The etiology of MCs is unknown; however, there are three causes which are considered the most probable today: mechanical, infectious and biochemical. They share a common mechanism of pro-inflammatory molecule migration from the degenerative disk. A close association has been identified and described between the MCs and a non-specific chronic low back pain. Disc degeneration ­exerts a further stress on the endplates and produces microcracks, through which the inflammatory mediators enter the bone marrow and provoke the MCs. At pre­sent, there are no evidence-based treatment protocols for the MCs. A certain progress has been made with antibiotic therapy, injections of steroids and antiresorbents; the effectiveness of anti-TNF-α therapy is being explored. The sporadic reference data on our disposal indicate that patients with MCs and chronic low back pain, along with instability, who do not respond to a conservative treatment, may be referred for the surgical treatment to relieve pain and improve quality of life. However, not all of the presented methods of surgical treatment with chronic back pain are effective in patients with the Mo­dic changes. The divergence of patient treatment outcomes presen­ted by various sources indicates the need for a further research to understand the MC pathogenesis and develop pathogenetic approaches to the treatment of this pathology