دورية أكاديمية
أعرض في EDS

Are Modic changes 'Primary infective endplatitis'?-insights from multimodal imaging of non-specific low back pain patients and development of a radiological 'Endplate infection probability score'.

التفاصيل البيبلوغرافية
العنوان: Are Modic changes 'Primary infective endplatitis'?-insights from multimodal imaging of non-specific low back pain patients and development of a radiological 'Endplate infection probability score'.
المؤلفون: Rajasekaran S; Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India. rajasekaran.orth@gmail.com., Pushpa BT; Department of Radiodiagnosis, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India., Soundararajan DCR; Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India., Sri Vijay Anand KS; Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India., Murugan C; Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India., Nedunchelian M; Department of Radiodiagnosis, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India., Kanna RM; Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India., Shetty AP; Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India., Tangavel C; Ganga Research Centre, 187, Mettupalayam Road, Koundampalayam, Coimbatore, India., Muthurajan R; Department of Plant Biotechnology, Tamil Nadu Agricultural University, Lawley Road, Coimbatore, India.
المصدر: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society [Eur Spine J] 2022 Nov; Vol. 31 (11), pp. 2884-2896. Date of Electronic Publication: 2022 Aug 05.
نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: Springer-Verlag Country of Publication: Germany NLM ID: 9301980 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-0932 (Electronic) Linking ISSN: 09406719 NLM ISO Abbreviation: Eur Spine J Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Heidelberg, Federal Republic of Germany : Springer-Verlag, c1992-
مواضيع طبية MeSH: Low Back Pain*/diagnostic imaging , Low Back Pain*/etiology , Intervertebral Disc Degeneration*/diagnostic imaging, Humans ; Lumbar Vertebrae ; Radiography ; Magnetic Resonance Imaging/adverse effects ; Probability ; Multimodal Imaging/adverse effects
مستخلص: Purpose: To probe the pathophysiological basis of Modic change (MC) by multimodal imaging rather than by MRI alone.
Methods: Nineteen radiological signs found in mild infections and traumatic endplate fractures were identified by MRI and CT, and by elimination, three signs unique to infection and trauma were distilled. By ranking the Z score, radiological 'Endplate Infection Probability Score' (EIPS) was developed. The score's ability to differentiate infection and traumatic endplate changes (EPC) was validated in a fresh set of 15 patients each, with documented infection and trauma. The EIPS, ESR, CRP, and Numeric Pain Rating Scale (NRS) were then compared between 115 patients with and 80 patients without MC.
Results: The EIPS had a confidence of 66.4%, 83% and, 100% for scores of 4, 5 and, 6, respectively, for end plate changes suggesting infection. The mean EIPS was 4.85 ± 1.94 in patients with Modic changes compared to - 0.66 ± 0.49 in patients without Modic changes (p < 0.001). Seventy-eight (67.64%) patients with MC had a score of 6, indicating high infection possibility. There was a difference in the NRS (p < 0.01), ESR (p = 0.05), CRP (p < 0.01), and type of pain (p < 0.01) between patients with and without MC.
Conclusion: Multimodal imaging showed many radiological signs not easily seen in MRI alone and thus missed in Modic classification. There were distinct radiological differences between EPCs of trauma and infection which allowed the development of an EIPS. The scores showed that 67.64% of our study patients with Modic changes had EPCs resembling infection rather than trauma suggesting the possibility of an infective aetiology and allowing us to propose an alternate theory of 'Primary Endplatitis'.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
References: Hartvigsen J, Hancock MJ, Kongsted A et al (2018) What low back pain is and why we need to pay attention. Lancet 391:2356–2367. https://doi.org/10.1016/S0140-6736(18)30480-X. (PMID: 10.1016/S0140-6736(18)30480-X29573870)
Jensen RK, Leboeuf-Yde C, Wedderkopp N et al (2012) Rest versus exercise as treatment for patients with low back pain and Modic changes a randomized controlled clinical trial. BMC Med 10:22. https://doi.org/10.1186/1741-7015-10-22. (PMID: 10.1186/1741-7015-10-22223767913348080)
Jensen TS, Karppinen J, Sorensen JS et al (2008) Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J 17:1407–1422. https://doi.org/10.1007/s00586-008-0770-2. (PMID: 10.1007/s00586-008-0770-2187878452583186)
Manniche C (2014) Vertebral endplate (modic) changes and the treatment of back pain using antibiotics. Clin Pract 11:585–590. https://doi.org/10.2217/cpr.14.69. (PMID: 10.2217/cpr.14.69)
Ninomiya K, Fujita N, Hosogane N et al (2017) Presence of Modic type 1 change increases risk of postoperative pyogenic discitis following decompression surgery for lumbar canal stenosis. J Orthop Sci 22:988–993. https://doi.org/10.1016/j.jos.2017.07.003. (PMID: 10.1016/j.jos.2017.07.00328802716)
Kumarasamy D, Rajasekaran S, Anand KSSV et al (2021) Lumbar disc herniation and preoperative modic changes: a prospective analysis of the clinical outcomes after microdiscectomy. Glob Spine J. https://doi.org/10.1177/2192568220976089. (PMID: 10.1177/2192568220976089)
Viswanathan VK, Shetty AP, Rajasekaran S (2020) Modic changes—an evidence-based, narrative review on its patho-physiology, clinical significance and role in chronic low back pain. J Clin Orthop Trauma 11:761–769. https://doi.org/10.1016/j.jcot.2020.06.025. (PMID: 10.1016/j.jcot.2020.06.025328795637452231)
Albert HB, Manniche C (2007) Modic changes following lumbar disc herniation. Eur Spine J 16:977–982. https://doi.org/10.1007/s00586-007-0336-8. (PMID: 10.1007/s00586-007-0336-8173347912219661)
Elfering A, Semmer N, Birkhofer D et al (2002) Risk factors for lumbar disc degeneration: a 5-year prospective MRI study in asymptomatic individuals. Spine (Phila Pa 1976) 27:125–134. https://doi.org/10.1097/00007632-200201150-00002. (PMID: 10.1097/00007632-200201150-00002)
Albert HB, Kjaer P, Jensen TS et al (2008) Modic changes, possible causes and relation to low back pain. Med Hypotheses 70:361–368. https://doi.org/10.1016/j.mehy.2007.05.014. (PMID: 10.1016/j.mehy.2007.05.01417624684)
Stirling A, Worthington T, Rafiq M et al (2001) Association between sciatica and Propionibacterium acnes. Lancet 357:2024–2025. https://doi.org/10.1016/S0140-6736(00)05109-6. (PMID: 10.1016/S0140-6736(00)05109-611438138)
Modic MT, Masaryk TJ, Ross JS, Carter JR (1988) Imaging of degenerative disk disease. Radiology 168:177–186. https://doi.org/10.1148/radiology.168.1.3289089. (PMID: 10.1148/radiology.168.1.32890893289089)
Rajashanker B, Whitehouse RW (2015) Chapter 53: Bone, joint and spinal Infection. In: Adam A, Dixon AK, Gillard JH, et al. editors. Grainger & Allison's Diagnostic Radiology, 6th ed. New York, NY: Churchill Livingstone, :1241-2.
Albert HB, Sorensen JS, Christensen BS, Manniche C (2013) Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy. Eur Spine J 22:697–707. https://doi.org/10.1007/s00586-013-2675-y. (PMID: 10.1007/s00586-013-2675-y234043533631045)
Wang F, Jiang J-M, Deng C-H et al (2011) Expression of Fas receptor and apoptosis in vertebral endplates with degenerative disc diseases categorized as Modic type I or II. Injury 42:790–795. https://doi.org/10.1016/j.injury.2011.01.034. (PMID: 10.1016/j.injury.2011.01.03421356536)
Rajasekaran S, Tangavel C, Aiyer SN et al (2017) ISSLS PRIZE IN CLINICAL SCIENCE 2017: Is infection the possible initiator of disc disease? an insight from proteomic analysis. Eur Spine J 26:1384–1400. https://doi.org/10.1007/s00586-017-4972-3. (PMID: 10.1007/s00586-017-4972-328168343)
Capoor MN, Ruzicka F, Machackova T et al (2016) Prevalence of propionibacterium acnes in intervertebral discs of patients undergoing lumbar microdiscectomy: a prospective cross-sectional study. PLoS ONE 11:e0161676. https://doi.org/10.1371/journal.pone.0161676. (PMID: 10.1371/journal.pone.0161676275367844990245)
Rajasekaran S, Tangavel C, KS SVA et al (2020) Inflammaging determines health and disease in lumbar discs-evidence from differing proteomic signatures of healthy, aging, and degenerating discs. Spine J. https://doi.org/10.1016/j.spinee.2019.04.023. (PMID: 10.1016/j.spinee.2019.04.02332344061)
Rajasekaran S, Soundararajan DCR, Nayagam SM et al (2021) Modic changes are associated with activation of intense inflammatory and host defense response pathways—molecular insights from proteomic analysis of human intervertebral discs. Spine J S1529–9430(21):00818–00824. https://doi.org/10.1016/j.spinee.2021.07.003. (PMID: 10.1016/j.spinee.2021.07.003)
Wang X, Xu F, Fu Y et al (2020) Traumatic vertebral fractures involve the anterior end plate more than the posterior end plate. Med (Baltimore) 99:e21572. https://doi.org/10.1097/MD.0000000000021572. (PMID: 10.1097/MD.0000000000021572)
Zhao F-D, Pollintine P, Hole BD et al (2009) Vertebral fractures usually affect the cranial endplate because it is thinner and supported by less-dense trabecular bone. Bone 44:372–379. https://doi.org/10.1016/j.bone.2008.10.048. (PMID: 10.1016/j.bone.2008.10.04819049912)
Rasouli MR, Mirkoohi M, Vaccaro AR et al (2012) Spinal tuberculosis: diagnosis and management. Asian Spine J 6:294–308. https://doi.org/10.4184/asj.2012.6.4.294. (PMID: 10.4184/asj.2012.6.4.294232758163530707)
Oki S, Matsuda Y, Shibata T et al (1996) Morphologic differences of the vascular buds in the vertebral endplate: scanning electron microscopic study. Spine (Phila Pa 1976) 21:174–177. https://doi.org/10.1097/00007632-199601150-00003. (PMID: 10.1097/00007632-199601150-00003)
Jha SC, Sairyo K (2020) The role of propionibacterium acnes in and Modic type 1 changes: a literature review. J Med Invest 67:21–26. https://doi.org/10.2152/jmi.67.21. (PMID: 10.2152/jmi.67.2132378611)
Rajasekaran S, Soundararajan DCR, Tangavel C et al (2020) Human intervertebral discs harbour a unique microbiome and dysbiosis determines health and disease. Eur Spine J 29:1621–1640. https://doi.org/10.1007/s00586-020-06446-z. (PMID: 10.1007/s00586-020-06446-z32409889)
فهرسة مساهمة: Keywords: Disc degeneration; Endplate changes; Endplate infection probability score; Imaging; Infection; Modic changes
تواريخ الأحداث: Date Created: 20220805 Date Completed: 20221108 Latest Revision: 20231020
رمز التحديث: 20231215
DOI: 10.1007/s00586-022-07335-3
PMID: 35931790
قاعدة البيانات: MEDLINE
الوصف
تدمد:1432-0932
DOI:10.1007/s00586-022-07335-3