Modic changes, possible causes and relation to low back pain
Modic changes, possible causes and relation to low back pain
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DOI：
10.1016/j.mehy.2007.05.014
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发表时间：
2008-01-01
影响因子：
4.7
通讯作者：
Manniche, Claus
中科院分区：
文献类型：
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作者：
Albert, H. B.;Kjaer, P.;Manniche, Claus
在腰痛(LBP)患者中，根据病理解剖只能诊断一小部分(约20%)。因此，迫切需要确定相关的LBP亚型，最好是在病理解剖学的基础上。终板附近椎体骨髓的MRI信号变化也称为Modic变化(MC)在LBP患者中很常见(18%-58%)，与LBP密切相关。在无症状的人中，患病率为12-13%。MC分为三种不同的类型。类型1由纤维血管组织组成，类型2为黄色脂肪，类型3为硬化骨。MC的时间演变尚不确定，但时间跨度为数年。在不同的特定感染性、退行性和免疫性疾病中，可观察到与疼痛相关的软骨下骨髓信号变化，如骨感染、骨关节炎、强直性脊柱炎和脊柱炎。在椎骨中，MC与椎体骨折、脊柱炎、椎间盘突出、严重的椎间盘退变、注射木瓜凝乳酶和急性Schmort‘s印象有关。本文的目的是提出导致MoDIC改变的两种可能的发病机制。这些是：机械原因：椎间盘退变导致软核材料的损失，椎间盘高度和静水压力降低，从而增加了终板上的剪切力，可能会发生微小骨折。观察到的MC可能代表继发于骨折和随后的炎症的水肿，或者是髓核有毒刺激渗入骨折的炎症过程的结果。细菌原因：在环状结构的外层纤维撕裂后，例如椎间盘突出，新的毛细血管和炎症在挤出的核物质周围发展。通过这种组织，厌氧细菌有可能进入厌氧盘，并在这种环境中引起缓慢发展的两种毒力感染。MC可能是感染周围炎症和水肿的明显迹象，因为厌氧细菌不能在MC 1型的高度需氧环境中茁壮成长。观点：如果被证明，所描述的一种或两种机制可能对这一特定的LBP患者亚组具有重要意义。因此，有可能为20-50%的LBP患者提供更准确和相关的诊断，并根据MC的潜在原因，开发有效的治疗方法，可能是抗生素、特殊康复方案、休息、稳定运动或手术固定。(C)2007爱思唯尔有限公司。保留所有权利。
In patients with low back pain (LBP) it is only possible to diagnose a small proportion, (approximately 20%), on a patho-anatomical basis. Therefore, the identification of relevant LBP subgroups, preferably on a patho-anatomical basis, is strongly needed.Signal changes on MRI in the vertebral body marrow adjacent to the end plates also known as Modic changes (MC) are common in patients with LBP (18-58%) and is strongly associated with LBP. In asymptomatic persons the prevalence is 12-13%. MC are divided into three different types. Type 1 consists of fibro vascular tissue, type 2 is yellow fat, and type 3 is sclerotic bone. The temporal evolution of MC is uncertain, but the time span is years.Subchondral bone marrow signal changes associated with pain can be observed in different specific infectious, degenerative and immunological diseases such as osseous infections, osteoarthritis, ankylosing spondytitis and spondytarthritis. In the vertebrae, MC is seen in relation to vertebrall fractures, spondytodiscitis, disc herniation, severe disc degeneration, injections with chymopapain, and acute Schmort's impressions.The aim of this paper is to propose two possible pathogenetic mechanisms causing Modic changes. These are: A mechanical cause: Degeneration of the disc causes loss of soft nuclear material, reduced disc height and hydrostatic pressure, which increases the shear forces on the endplates and micro fractures may occur. The observed MC could represent oedema secondary to the fracture and subsequent inflammation, or a result of an inflammatory process from a toxic stimulus from the nucleus pulposus that seeps through the fractures.A bacterial cause: Following a tear in the outer fibres of the annulus e.g. disc herniation, new capilarisation and inflammation develop around the extruded nuclear material. Through this tissue it is possible for anaerobic bacteria to enter the anaerobic disc and in this environment cause a slowly developing tow virulent infection. The MC could be the visible signs of the inflammation and oedema surrounding this infection, because the anaerobic bacteria cannot thrive in the highly aerobic environment of the MC type 1.Perspectives: One or both of the described mechanisms can - if proven - be of significant importance for this specific subgroup of patients with LBP. Hence, it would be possible to give a more precise and relevant diagnosis to 20-50% of patients with LBP and enable in the development of efficient treatments which might be antibiotics, special rehabilitation programmes, rest, stabilizing exercise, or surgical fixation, depending on the underlying cause for the MC. (c) 2007 Elsevier Ltd. All rights reserved.