Evidence map›Paper›PMID 26914098›Full record

SynthesisEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2016

Pathobiology of Modic changes.

Stefan Dudli, Aaron J Fields, Dino Samartzis, Jaro Karppinen, Jeffrey C Lotz

Registry-linked trialOpen access · greenAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in 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, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05660512 (A Prospective Single Arm Cohort Study of Intraosseous Basivertebral Nerve Ablation), which is not on this map. Cited by 235 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
235citing papers in PubMed, 8 pooled it
17.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05660512 active not recruitingnot on this mapstarted 2020, after this paper: background citation

A Prospective Single Arm Cohort Study of Intraosseous Basivertebral Nerve Ablation

TypeobservationalSponsorUniversity of UtahRan2020 to 2026Enrolled150ConditionsLow Back PainArmsIntracept Procedure
3 · Its place in the literature

Who cites it

235 citing papers in PubMed, 8 syntheses or guidelines pooled it, 368 citations in OpenAlex.

  1. Pooled it
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  5. Are current machine learning applications comparable to radiologist classification of degenerate and herniated discs and Modic change? A systematic review and meta-analysis.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 · 2023
    Pooled it
  6. Pooled it
  7. Evidence for infection in intervertebral disc degeneration: a systematic review.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 · 2022
    Pooled it
  8. Measuring and reporting of vertebral endplate bone marrow lesions as seen on MRI (Modic changes): recommendations from the ISSLS Degenerative Spinal Phenotypes Group.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 · 2019
    Guideline
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  13. Long-term outcomes following intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: 5-year treatment arm results from a prospective randomized double-blind sham-controlled multi-center study.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 · 2020
    Trial
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  18. A prospective, open-label, single-arm, multi-center study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain.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 · 2019
    Trial
  19. Anatomy of the basivertebral nerve and its implications in the vertebrogenic pain. Systematic review and mapping of evidence.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 · 2026
    Review
  20. Article

175 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 3 countries.

Stefan DudliDepartment of Orthopaedic Surgery, University of California San Francisco, 513 Parnassus Ave, S-1164, San Francisco, CA, 94143-0514, USA. dudli@panamerica.ch.
Aaron J FieldsDepartment of Orthopaedic Surgery, University of California San Francisco, 513 Parnassus Ave, S-1164, San Francisco, CA, 94143-0514, USA.
Dino SamartzisDepartment of Orthopaedics and Traumatology, University of Hong Kong, Hong Kong, China.
Jaro KarppinenDepartment of Physical and Rehabilitation Medicine, Medical Research Center Oulu, Finnish Institute of Occupational Health, University of Oulu and Oulu University Hospital, Oulu, Finland.
Jeffrey C LotzDepartment of Orthopaedic Surgery, University of California San Francisco, 513 Parnassus Ave, S-1164, San Francisco, CA, 94143-0514, USA.
University of California, San Francisco · USOulu University Hospital · FIUniversity of Hong Kong · HK

Funding

Phenotypes of pathologic vertebral endplate degenerationR01AR063705 · NIAMS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI LOTZ, JEFFREY C. · 2013 to 2017
$3.0M
Phenotypes of pathologic vertebral endplate degenerationR56AR063705 · NIAMS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI LOTZ, JEFFREY C. · 2019 to 2019
$669k
NIAMS NIH HHS R01 AR063705NIAMS NIH HHS R56 AR063705
6 · The paper itself

Abstract

purposeLow back pain (LBP) is the most disabling condition worldwide. Although LBP relates to different spinal pathologies, vertebral bone marrow lesions visualized as Modic changes on MRI have a high specificity for discogenic LBP. This review summarizes the pathobiology of Modic changes and suggests a disease model.

methodsNon-systematic literature review.

resultsChemical and mechanical stimulation of nociceptors adjacent to damaged endplates are likely a source of pain. Modic changes are adjacent to a degenerated intervertebral disc and have three generally interconvertible types suggesting that the different Modic change types represent different stages of the same pathological process, which is characterized by inflammation, high bone turnover, and fibrosis. A disease model is suggested where disc/endplate damage and the persistence of an inflammatory stimulus (i.e., occult discitis or autoimmune response against disc material) create predisposing conditions. The risk to develop Modic changes likely depends on the inflammatory potential of the disc and the capacity of the bone marrow to respond to it. Bone marrow lesions in osteoarthritic knee joints share many characteristics with Modic changes adjacent to degenerated discs and suggest that damage-associated molecular patterns and marrow fat metabolism are important pathogenetic factors. There is no consensus on the ideal therapy. Non-surgical treatment approaches including intradiscal steroid injections, anti-TNF-α antibody, antibiotics, and bisphosphonates have some demonstrated efficacy in mostly non-replicated clinical studies in reducing Modic changes in the short term, but with unknown long-term benefits. New diagnostic tools and animal models are required to improve painful Modic change identification and classification, and to clarify the pathogenesis.

conclusionModic changes are likely to be more than just a coincidental imaging finding in LBP patients and rather represent an underlying pathology that should be a target for therapy.

Indexed as

Magnetic Resonance ImagingBone MarrowHumansIntervertebral DiscLow Back PainLumbar VertebraeModels, BiologicalBone marrow lesionEndplate damageLow back painModic changesPathobiology

Identifiers

PMID26914098
PMCPMC5477843
OpenAlexW2290008885

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.