Pathobiology of Modic changes.
Pathobiology of Modic changes.
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DOI：
10.1007/s00586-016-4459-7
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发表时间：
2016-11
期刊：
影响因子：
--
通讯作者：
Lotz JC
中科院分区：
文献类型：
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作者：
Dudli S;Fields AJ;Samartzis D;Karppinen J;Lotz JC
下背痛（LBP）是世界上最严重的致残性疾病。尽管腰椎间盘突出症与不同的脊柱病理有关，但MRI上表现为Modic改变的椎体骨髓病变对椎间盘源性腰椎间盘突出症具有高度特异性。本文综述了Modic改变的病理生物学，并提出了一种疾病模型。非系统性文献综述。邻近受损终板的伤害感受器的化学和机械刺激可能是疼痛的来源。Modic改变邻近退变的椎间盘，并且具有三种通常可相互转换的类型，这表明不同的Modic改变类型代表相同病理过程的不同阶段，其特征在于炎症、高骨转换和纤维化。提出了一种疾病模型，其中椎间盘/终板损伤和炎性刺激的持续（即，隐匿性椎间盘炎或针对椎间盘物质的自身免疫反应）产生诱发条件。发生Modic改变的风险可能取决于椎间盘的炎症潜能和骨髓对它的反应能力。骨关节炎膝关节的骨髓病变与邻近退行性椎间盘的Modic改变有许多共同特征，并表明损伤相关的分子模式和骨髓脂肪代谢是重要的致病因素。对于理想的治疗方法没有共识。非手术治疗方法包括椎间盘内类固醇注射、抗TNF-α抗体、抗生素和双膦酸盐在大多数非重复临床研究中证明了在短期内减少Modic变化的疗效，但长期获益未知。需要新的诊断工具和动物模型来改善疼痛性Modic改变的识别和分类，并阐明发病机制。Modic改变可能不仅仅是LBP患者的偶然影像学发现，而是代表了一种潜在的病理学，应该成为治疗的目标。
Low 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. Non-systematic literature review. Chemical 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. Modic 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.