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Vertebral endplate signal changes not associated with back pain in sciatica
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NEW ORLEANS — In contrast with current practice, researchers in the Netherlands have discovered that vertebral endplate signal changes do not appear to be associated with disabling back pain in patients with sciatica, according to data presented at the North American Spine Society Annual Meeting, here.
Abdelilah el Barzouhi, MD, MSc, of the department of neurosurgery at Leiden University Medical Center, in Leiden, Netherlands, and his colleagues conducted a randomized clinical trial to evaluate vertebral endplate signal changes, or Modic changes, over time and the correlation between Modic changes and disabling back pain. They obtained the patient sample they used from among participants in a multicenter randomized clinical trial comparing early surgery and prolonged conservative care in patients who had sciatica for 6 weeks to 12 weeks.
“Surgery for sciatica was highly associated with the development of Modic changes after 1 year, especially type 1 Modic changes,” el Barzouhi said. “But in contrast to our intuitive feeling, those with and without Modic changes reported disabling back pain in nearly the same proportion. Therefore, vertebral endplate signal changes do not seem to be responsible for the disabling back pain in patients with sciatica.”
MRI, VAS results
Images: el Barzouhi A
Researchers assessed patients’ back pain at baseline and 1-year follow-up using a 100-point VAS score. They defined disabling back pain as a score of at least 40 points. Patients also underwent MRI at baseline and the 1-year follow-up.
At baseline, 39% of patients reported disabling back pain. Forty percent of patients with Modic changes at baseline (112 patients) had disabling back pain compared with 38% of those without Modic changes at baseline (151 patients).
The prevalence of type 1 Modic changes increased from 1% at baseline to 35% at 1 year in the surgical group (168 patients). In the 95 patients in the conservative treatment group, the prevalence of type 1 Modic changes increased from 3% to 11% during this same time period. The rate of type 2 Modic changes decreased from 40% at baseline to 29% at 1 year follow-up in the surgical group, but the rate remained nearly stable, from 41% to 42%, in the conservative treatment group.
Surgery or conservative care
“We learned that back pain, in fact, diminished over time,” el Barzouhi said. “In both groups of surgically treated patients — those with Modic changes and those without — back pain diminished after inclusion at baseline with no differences in the rate of back pain at 1-year follow-up. The same results were seen in patients who were treated conservatively.”
The prevalence of disabling back pain at 1 year was 12% in patients with no Modic changes, 16% in patients with type 1 Modic changes, 11% in patients with type 2 Modic changes, and 3% in patients with both type 1 and type 2 Modic changes. “There were no significant differences in the prevalence of back pain between the four groups,” el Barzouhi said.
Undergoing surgery was associated with an 8.6 times greater likelihood of having an increase in the extent of Modic changes; at one-year follow-up, 67% of surgically treated patients showed an increase in the extent of Modic changes compared with 19% of conservatively treated patients. However, patients who showed an increase in the extent of Modic changes after one year did not report significantly more disabling back pain compared with patients who did not show any increase. – by Tina DiMarcantonio
- Reference:
- el Barzouhi A. Back pain’s association with vertebral endplate signal changes in sciatica. Presented at: North American Spine Society Annual Meeting; Oct. 9-12, 2013; New Orleans.
- For more information:
- Abdelilah el Barzouhi, MD, MSc, can be reached at the Department of Neurosurgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands; email: a.el_barzouhi@lumc.nl.
Disclosure: This research was supported by grants from the Netherlands Organisation for Health Research and Development and Hoelen Foundation, the Hague. El Barzouhi has no relevant financial disclosures.