Inflammation of the vertebrae (Modic changes)
Description of modic changes

Modic changes refers to pathological changes that are present in the bones of the spine called vertebra. Modic changes were first analyzed and described by Dr. Michael Modic in 1988. The changes were later modified into three types depending on the development of the disease. These changes can only be seen on MRI scans and may occur in the vertebral body as well as in the end plates of the adjacent discs. Modic changes are a disease process associated with inflammation of the vertebrae of the spine and is most often discovered when a patient with back pain does not respond to physiotherapeutic or manual treatment.

The bones consist of collagen strands which can withstand very large pressure, and between the strands lie the red bone marrow. It is in this section that a chronic inflammation occurs which then destroys the collagen. Modical changes are a process which can’t be healed and the patient often experiences recurring pain locally and reduced mobility. Research has shown that up to 80% of patients experiencing modic changes have constant pain, which makes it difficult to perform everyday activity or just get a night’s sleep as since finding a resting position without pain can be difficult. One study has shown that many people discover modic changes after a herniated disc, where the disc nucleus irritates the bone tissue, creating an intraosseous inflammatory condition, while the body simultaneously creates small pain receptors which increase the pain.

As the condition changes, the patient may develop stenosis and compression of the spinal nerves. Modic changes are divided into three types, namely Type I, Type II and Type III. Modic changes are a dynamic process, which means it slowly changes from Type I to Type II to Type III. Studies have not yet found a single patient where the condition has gone away.

Symptoms of modic changes
  • Pain in the back that is constant or swings up and down without disappearing.
  • Pain which inhibits sleep over a long period of time.
  • Pain experience is not improved by treatment with physical therapy or other types of therapy.
Examination of modic objections

Type I modic changes are a rapid unstable and destructive form of spinal degeneration, with inflammation which causes edema (bleeding) in the bone. The condition is discovered through MRI scan, where T2 is of high intensity and T1 is low (see below what it means).
In type II much of the bone has eroded and has been replaced by fat, which of course causes the bone to weaken and compress. You also see increased vasodilation (enlargement of blood vessels). Here, both the T1 and T2 signal will be increased.

At the final stage, type III there is hardly any bone left, and the signal from T1 and T2 is now low, but you can often see the condition by X-ray.

  • T1 scans end planes: Type I = Low signal, Type II = Increased signal, Type III = Low signal.
  • T2 scans the cerebrospinal fluid: Type I = increased signal, Type II = increased signal, Type III = weak signal.

The examining physician should be aware that the patient may also have disc inflammation, osteomyelitis or something else malignant (having the tendency to become progressively worse).

Treatment of modic changes
It is extremely difficult to reach effective results from ttherapy for modic changes. The higher the type the more difficult the condition is to treat. Many try with intense antibiotics treatments in extremely high doses. Often patients get very sick and the effect is rarely positive. Exercise therapy that would be given to all other patients with back pain also does not seem to have any effect, and patients therefore discontinue treatment because movements cause more pain.

Therapy that has been shown to have a reasonable effect on these patients is Class 4 laser, such as a K laser. However, patients should typically have between 12-16 treatments over 6 weeks before a significant improvement can be found. And since the patients themselves have to pay for such a therapy, it may exclude many, though it seems as though it will be the best therapy.