TY - JOUR

T1 - The Clinical Significance of the Modic Changes Grading Score

AU - Udby, Peter M.

AU - Modic, Michael

AU - Elmose, Signe

AU - Carreon, Leah Y.

AU - Andersen, Mikkel Ø.

AU - Karppinen, Jaro

AU - Samartzis, Dino

N1 - Publisher Copyright: © The Author(s) 2022.

PY - 2024

Y1 - 2024

N2 - Study design: Cross-sectional retrospective observational study. Objective: To evaluate the reliability and clinical utility of the Modic changes (MC) grading score. Method: Patients from the Danish national spine registry, DaneSpine, scheduled for lumbar discectomy were identified. MRI of patients with MC were graded based on vertical height involvement: Grade A (<25%), Grade B (25%-50%), and Grade C (>50%). All MRIs were reviewed by 2 physicians to evaluate the reliability of the MC grade. Results: Of 213 patients included, 142 patients had MC, 71 with MC-1 and 71 with MC-2; 34% were Grade A, 45% were Grade B, and 21% were Grade C. MC grade demonstrated substantial intra-rater (κ =.68) and inter-rater (κ =.61) reliability. A significantly higher proportion (n = 40, 57%) of patients with MC-1 had a severe MC grade compared to patients with MC-2 (n = 30, 43%, P <.001). Severe MC grade was associated with the presence of severe lumbar disc degeneration (DD) (Pfirrmann grade = V, P =.024), worse preoperative ODI (52.49 vs 44.17, P =.021) and EQ-5D scores (.26 vs.46, P =.053). MC alone including type was not associated with a significant difference in patient-reported outcomes (P >.05). Conclusion: The MC grade score was demonstrated to have substantial intra- and inter-observer reliability. Severe MC grade was associated with both severe DD and MC type, being more prevalent in patients with MC-1. The MC grade was also significantly associated with worse disability and reduced health-related quality of life. Results from the study suggest that MC grade is more clinically important than MC type.

AB - Study design: Cross-sectional retrospective observational study. Objective: To evaluate the reliability and clinical utility of the Modic changes (MC) grading score. Method: Patients from the Danish national spine registry, DaneSpine, scheduled for lumbar discectomy were identified. MRI of patients with MC were graded based on vertical height involvement: Grade A (<25%), Grade B (25%-50%), and Grade C (>50%). All MRIs were reviewed by 2 physicians to evaluate the reliability of the MC grade. Results: Of 213 patients included, 142 patients had MC, 71 with MC-1 and 71 with MC-2; 34% were Grade A, 45% were Grade B, and 21% were Grade C. MC grade demonstrated substantial intra-rater (κ =.68) and inter-rater (κ =.61) reliability. A significantly higher proportion (n = 40, 57%) of patients with MC-1 had a severe MC grade compared to patients with MC-2 (n = 30, 43%, P <.001). Severe MC grade was associated with the presence of severe lumbar disc degeneration (DD) (Pfirrmann grade = V, P =.024), worse preoperative ODI (52.49 vs 44.17, P =.021) and EQ-5D scores (.26 vs.46, P =.053). MC alone including type was not associated with a significant difference in patient-reported outcomes (P >.05). Conclusion: The MC grade score was demonstrated to have substantial intra- and inter-observer reliability. Severe MC grade was associated with both severe DD and MC type, being more prevalent in patients with MC-1. The MC grade was also significantly associated with worse disability and reduced health-related quality of life. Results from the study suggest that MC grade is more clinically important than MC type.

KW - degeneration

KW - disc

KW - endplate

KW - low back pain

KW - magnetic resonance imaging

KW - modic changes

U2 - 10.1177/21925682221123012

DO - 10.1177/21925682221123012

M3 - Journal article

C2 - 35998235

AN - SCOPUS:85136654655

VL - 14

SP - 796

EP - 803

JO - Global Spine Journal

JF - Global Spine Journal

SN - 2192-5682

IS - 3

ER -