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Modic Changes

What are Modic changes?

Modic changes (MC) are painful vertebral bone marrow lesions visualized as signal intensity changes by magnetic resonance imaging (MRI). Based on their appearance on T1-weighted and T2-weighted MRI, three interconvertible types (MC1, MC2, MC3) are distinguished, whereby MC1 seem to be the most painful. MC are highly prevalent in chronic low back pain patients (43 % vs. 6 % in the asymptomatic population) and patients with MC are an “entity on its own” that exhibit an “inflammatory pain pattern”. The pain seems to result from the increased nerve fiber density found in vertebral endplates of patients with MCs. Despite their high prevalence, only little is known about the MC pathobiology. Few histological studies of MC bone marrow showed bone marrow inflammation, fibrosis, and high bone turnover in MC1, inflammation, fatty marrow replacement of normal bone marrow, and reduced bone turnover in MC2, and a stable sclerotic state in MC3.

The intervertebral discs (IVDs) and the vertebral endplates seem to critically contribute to the MC pathobiology, as the MC bone marrow lesions usually occur symmetric above and below degenerated IVDs and they strongly associate with endplate damage.  How MC develop is poorly understood, but there is biological plausibility for a bacterial and an autoimmune etiology. In the bacterial etiology, it is suggested that anaerobic aerotolerant Cutibacterium acnes (C. acnes) invade damaged IVDs resulting in IVD infection and endplate damage. IVD-derived pro-inflammatory cytokines and virulence factors can consequently drain into the adjacent bone marrow and induce an inflammatory response. In the autoimmune etiology, IVD and endplate damage expose immune privileged IVD cells and matrix to bone marrow leukocytes, which react with an autoimmune response.

To date, no MC specific targeted treatments exist. Hence, we dedicate ourselves to investigate the pathomechanisms  of this disabling disease and work on the identification of MC biomarkers and the development of MC specific treatment.

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