Distribution of Modic changes in patients with low back pain and its related factors

BACKGROUND: To summarize the clinical distribution of Modic changes in patients with low back pain and explore the related factors. METHODS: A total of 153 patients were enrolled. Gender, age, disk degeneration, herniation, involved segments, lumbar lordosis angle, and endplate concave angle were recorded, respectively. Patients were divided into two or more groups according to a different classification. The relevant factors were studied with a multivariate logistic regression analysis to analyze their correlation. RESULTS: A total of 35 patients with type I changes, 110 patients with type II changes, and 8 patients with type III changes. In total, 204 disks were found with Modic changes, L1/2 (10 disks), L2/3 (18 disks), L3/4 (17 disks), L4/5 (76 disks), and L5/S1 (81 disks). Type I changes were distributed mainly under the age of 50. Multivariate regression showed that gender, age, disk degeneration, lumbar lordosis, L4/5 segment lordosis angle, and L5 lower endplate concave angle were related with different types of Modic changes. The regression equation Y = 2.410 − 1.361S − 0.633A − 0.654P + 1.106L − 0.990D (Y means type I changes, S means gender, A means age, P means disk degeneration, L means L4/5 segment lordosis angle, and D means L5 upper endplate concave angle). The OR values were S = 0.256, A = 0.531, P = 0.520, L = 3.022, D = 0.372, respectively. CONCLUSIONS: Type II changes are the most common, followed by type I. Modic changes mostly occur in L4/5 and L5/S1; young, male, lower-grade disk degeneration, normal physiological curvature of the lumbar spine, and normal endplate concave angle were associated with type I changes; gender and lumbar curvature were the most relevant factors for different types.