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
Modic changes, chronic low back pain, and lifestyle and mental health factors: a cross-sectional analysis of a cohort study.
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Mitchell Ulrike H, Clay Kassity D, McCauley Mitchell, Wengreen Matthew, Samanna Claire L
Аннотация
PURPOSE: Modic changes (MC) are vertebral endplate and adjacent bone marrow MRI findings that have been associated with chronic low back pain (CLBP), although their clinical relevance remains debated. This study examined whether MC presence and extent are associated with CLBP status, pain intensity, and disability, and whether lifestyle or mental health factors moderate the MC-pain relationship.
METHODS: This exploratory cross-sectional sub-study included 239 adults: 135 with CLBP and 104 controls without. Lumbar MRI scans were evaluated for MC presence, type, craniocaudal extent of vertebral body involvement, and transverse extent of endplate involvement. Firth penalized logistic regression examined associations of MC presence, type and extent with CLBP status. Linear regression models examined associations between aggregated MC count and vertebral body and endplate extent with low back pain intensity and disability within CLBP and control groups. Moderation analyses tested whether sleep disturbance, physical activity, anxiety, depression, or pain catastrophizing modified the association between MC count and low back pain intensity among individuals with CLBP. All models were adjusted for age, sex, smoking, and body mass index.
RESULTS: Any MC were associated with higher odds of CLBP (OR 2.50, 95% CI 1.45-4.30; p = 0.001), with similar associations for Type 1 and Type 2 MC. Greater vertebral body involvement showed a graded association with CLBP, with > 50% vertebral body involvement associated with the highest odds (OR 4.88, 95% CI 1.14-20.92; p = 0.033). Among individuals with CLBP, aggregated MC count (β = 0.30, 95% CI 0.05-0.55; p = 0.019) and vertebral body extent (β = 0.11, 95% CI 0.01-0.21; p = 0.039) were associated with higher pain intensity, but not disability. Endplate extent was not associated with pain or disability. None of the examined lifestyle or psychological factors significantly moderated the MC-pain association.
CONCLUSION: This exploratory analysis revealed that MC, particularly those with greater vertebral body involvement, were associated with CLBP status and low back pain intensity. Lifestyle and psychological factors were related to pain severity but did not significantly modify the MC-pain relationship. These findings suggest that MC extent may be a clinically relevant imaging characteristic, although longitudinal studies are needed to clarify causality and prognostic significance.
METHODS: This exploratory cross-sectional sub-study included 239 adults: 135 with CLBP and 104 controls without. Lumbar MRI scans were evaluated for MC presence, type, craniocaudal extent of vertebral body involvement, and transverse extent of endplate involvement. Firth penalized logistic regression examined associations of MC presence, type and extent with CLBP status. Linear regression models examined associations between aggregated MC count and vertebral body and endplate extent with low back pain intensity and disability within CLBP and control groups. Moderation analyses tested whether sleep disturbance, physical activity, anxiety, depression, or pain catastrophizing modified the association between MC count and low back pain intensity among individuals with CLBP. All models were adjusted for age, sex, smoking, and body mass index.
RESULTS: Any MC were associated with higher odds of CLBP (OR 2.50, 95% CI 1.45-4.30; p = 0.001), with similar associations for Type 1 and Type 2 MC. Greater vertebral body involvement showed a graded association with CLBP, with > 50% vertebral body involvement associated with the highest odds (OR 4.88, 95% CI 1.14-20.92; p = 0.033). Among individuals with CLBP, aggregated MC count (β = 0.30, 95% CI 0.05-0.55; p = 0.019) and vertebral body extent (β = 0.11, 95% CI 0.01-0.21; p = 0.039) were associated with higher pain intensity, but not disability. Endplate extent was not associated with pain or disability. None of the examined lifestyle or psychological factors significantly moderated the MC-pain association.
CONCLUSION: This exploratory analysis revealed that MC, particularly those with greater vertebral body involvement, were associated with CLBP status and low back pain intensity. Lifestyle and psychological factors were related to pain severity but did not significantly modify the MC-pain relationship. These findings suggest that MC extent may be a clinically relevant imaging characteristic, although longitudinal studies are needed to clarify causality and prognostic significance.