Local low-back pain: modern view on diagnosis and drug therapy

M.M. Oros, H.V. Palahuta


The paper deals with differential diagnosis of several reasons for low-back pain that often cause difficulties in interpretation of clinical findings, estimation of laboratory parameters and MRI results. The terms of pathological Modic I type changes in lumbar spine and spondylitis are defined. The paper presents the basic moments in differential diagnosis of Modic I type changes and early non-specific spondylitis in MRI in the case of low-back pain. The description of MR images in these pathologies along with the basic clinical signs and management of these patients according to the international studies are considered.


low-back pain; MRI; spondylitis; Modic I; De-Span; Asprix


Vos T., Flaxman A., Naghavi M. et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990­2010: a sys-tematic analysis for the Global Burden of Disease Study 2010. The Lancet. 2012. 380 (9859). Р. 2163­2196.

Maurits van Tulder M., Koes B., Bombardier C. Low Back Pain. Best Practice & Research Clinical Rheumatology. 2002. Vol. 16. № 5. Р. 761­775.

Maher C., Underwood M., Buchbinder R. Non­specific low back pain. The Lancet. 2017. 389 (10070). Р. 736­747.

Bardin L.D., King P., Maher C.G. Diagnostic triage for low back pain: a practical approach for primary care. Med. J. Aust 2017. 206 (6). Р. 268­273.

Fritz J.M., Brennan G.P., Clifford S.N., Hunter S.J., Thackeray A. An examination of the reliability of a classification algorithm for subgroup-ing patients with low back pain. Spine (Phila Pa 1976). 2006. 31 (1). Р. 77­82.

Brinjikji W., Diehn F.E., Jarvik J.G., Carr C.M., Kallmes D.F., Murad M.H. et al. MRI Findings of Disc Degeneration Are More Pre­valent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta­Analysis. AJNR Am. J. Neuroradiol. 2015. 36 (12). Р. 2394­9. doi: 10.3174/ajnr.A4498.

Chou D., Samartzis D., Bellabarba C., Patel A., Luk K.D., Kisser J.M. et al. Degenerative magnetic resonance imaging changes in patients with chronic low back pain: a systematic review. Spine (Phila Pa 1976). 2011. 36 (21 Suppl). S43­53. doi: 10.1097/BRS.0b013e31822ef700.

Albert H.B., Kjaer P., Jensen T.S., Sorensen J.S., Bendix T., Manniche C. Modic changes, possible causes and relation to low back pain. Med. Hypotheses. 2008. 70 (2). Р. 361­8. doi: 10.1016/j.mehy. 2007.05.014.

Modic M., Steinberg P., Ross J., Masaryk T., Carter J. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988. Vol. 166. № 1. Р. 193­199.

De Roos A., Kressel H., Spritzer C., Dalinka M. MR ima­ging of marrow changes adjacent to end plates in degenerative lumbar disk dis-ease. American Journal of Roentgenology. 1987. 149 (3). P. 531­534.

Fields A., Liebenberg E., Lotz J. Innervation of pathologies in the lumbar vertebral end plate and intervertebral disc. The Spine Journal. 2014. 14 (3). P. 513­521.

Mitra D., Cassar­Pullicino V., Mccall I. Longitudinal study of vertebral type­1 end­plate changes on MR of the lumbar spine. Eur. Radiol. 2004. 14 (9).

Jarvik J., Hollingworth W., Heagerty P., Haynor D., Boyko E., Deyo R. Three­Year Incidence of Low Back Pain in an Initially Asympto-matic Cohort. Spine. 2005. 30 (13). P. 1541­1548.

Jensen T., Bendix T., Sorensen J., Manniche C., Korsholm L., Kjaer P. Characteristics and natural course of vertebral endplate signal (Modic) changes in the Danish general population. BMC Musculoske­letal Disorders. 2009. 10 (1). 81.

Hutton M., Bayer J., Powell J. Modic Vertebral Body Changes. Spine. 2011. 36 (26). P. 2304­2307.

Jensen T.S., Karppinen J., Sorensen J.S. et al. Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non­specific low back pain. Eur. Spine J. 2008. 17 (11). P. 1407­1422.

Leboeuf­Yde C., Kjær P., Bendix T., Manniche C. Self­repor­ted hard physical work combined with heavy smoking or overweight may re-sult in so­called Modic changes. BMC Musculoskeletal Disorders. 2008. 9(1). 5.

Karchevsky M., Schweitzer M., Carrino J., Zoga A., Montgomery D., Parker L. Reactive endplate marrow changes: a systematic mor-phologic and epidemiologic evaluation. Skeletal Radiol. 2005. 34(3). P. 125­129.

Ohtori S., Inoue G., Ito T., Koshi T., Ozawa T., Doya H. et al. Tumor necrosis factor­immunoreactive cells and PGP 9.5-immunoreactive nerve fibers in vertebral endplates of patients with discogenic low back pain and Modic type 1 or type 2 changes on MRI. Spine. 2006. 31. P. 1026­31.

Adams M., Freeman B., Morrison H., Nelson I., Dolan P. Mechanical Initiation of Intervertebral Disc Degeneration. Spine. 2000. 25 (13). P. 1625­1636.

Braithwaite I., White J., Saifuddin A., Renton P., Taylor B. Vertebral endplate (Modic) changes on lumbar spine MRI: correlation with pain reproduction at lumbar discography. European Spine Journal. 1998. 7 (5). P. 363­368.

Ohtori S., Koshi T., Yamashita M. et al. Existence of pyogenic spondylitis in Modic type 1 change without other signs of infection: 2­year follow­up. Eur. Spine J. 2010. 19 (7). P. 1200­1205.

Albert H., Sorensen J., Christensen B., Manniche C. Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double­blind randomized clinical controlled trial of efficacy. European Spine Journal. 2013. 22(4). P. 697­707.

Jensen O., Nielsen C., Sørensen J., Stengaard­Pedersen K. Back pain was less explained than leg pain: a cross­sectional study using magnetic resonance imaging in low back pain patients with and without radiculopathy. BMC Musculoskeletal Disord. 2015. 3 (16). 374.

Sheng­Yun L., Letu S., Jian C. et al. Comparison of Modic changes in the lumbar and cervical spine, in 3167 patients with and without spinal pain. PloS ONE. 2014. 9 (12). e114993.

Steffens D., Hancock M., Maher C. et al. Does magnetic resonance imaging predict future low back pain? A systematic review. Eur. J. Pain. 2014. 18 (6). P. 755­765.

Bailly F., Maigne J., Genevay S. Inflammatory pain pattern and pain with lumbar extension associated with Modic 1 changes on MRI: a prospective case­control study of 120 patients. Eur. Spine J. 2014. 23 (3). P. 493­497.

Vital J., Gille O., Pointillart V. et al. Course of Modic 1 Six Months After Lumbar Posterior Osteosynthesis. Spine. 2003. 28(7). P. 715­720.

Beaudreuil J., Dieude P., Poiraudeau S., Revel M. Disabling chronic low back pain with Modic type 1 MRI signal: Acute reduction in pain with intradiscal corticotherapy. Annals of Physical and Rehabilitation Medicine. 2012. 55(3). P. 139­147.

Koivisto K., Kyllönen E., Haapea M., Niinimäki J., Sundqvist K., Pehkonen T., Seitsalo S., Tervonen O., Karppinen J. Efficacy of zoledron-ic acid for chronic low back pain associated with Modic changes in magnetic resonance imaging. BMC Musculoskelet. Disord. 2014 Mar 4. 15. Р. 64.

Mylona E., Samarkos M., Kakalou E., Fanourgiakis P., Skoutelis A. Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin. Arthritis Rheum. 2009. 39. P. 10­7.

Zimmerli W. Clinical practice. Vertebral osteomyelitis. N. Engl. J. Med. 2010. 362 (11). P. 1022­1029.

Ablin G., Erickson T.C. Osteomyelitis of cervical vertebrae (and quadriparesis) secondary to urinary tract infection: case report and re-view of literature. J. Neurosurg. 1958. 15 (4). P. 455­459.

Leone A., Dell’Atti C., Magarelli N., Colelli P., Balanika A., Casale R. et al. Imaging of spondylodiscitis. Eur. Rev. Med. Pharmacol. Sci. 2012. 16 Suppl. 2. P. 8­19.

Go J.L., Rothman S., Prosper A., Silbergleit R., Lerner A. Spine infections. Neuroimaging Clin. N. Am. 2012. 22. P. 755­772.

Ratcliffe J.F. The arterial anatomy of the developing human dorsal and lumbar vertebral body. A microarteriographic study. J. Anat. 1981. 133 (Pt 4). P. 625­638.

Dagirmanjian A., Schils J., McHenry M.C. MR imaging of spinal infections. Magn. Reson. Imaging. Clin. N. Am. 1999. 7. P. 525­538.

Wiley A.M., Trueta J. The vascular anatomy of the spine and its relationship to pyogenic vertebral osteomyelitis. J. Bone Joint Surg. Br. 1959. 41­B. P. 796­809.

Maiuri F., Iaconetta G., Gallicchio B., Manto A., Briganti F. Spondylodiskitis: clinical and magnetic resonance diagnosis. Spine. 1997. 22. P. 1741­1746.

Van Tassel P. Magnetic resonance imaging of spinal infections. Top Magn. Reson. Imaging. 1994. 6. P. 69­81.

Resnik D. Osteomyelitis, septic arthritis and soft tissue infection: axial skeleton. In: Resnick D, ed. Diagnosis of bone and joint disorders. 4th ed. Philadelphia, Pa: Saunders, 2002. P. 2481­2509.

Abram S.R., Tedeschi A.A., Partain C.L., Blumenkopf B. Differential diagnosis of severe back pain using MRI. South Med. J. 1988. 81 (12). P. 1487­1492.

Gupta A., Kowalski T.J., Osmon D.R. et al. Long­term outcome of pyogenic vertebral osteomyelitis: a cohort study of 260 patients. Open Forum Infect. Dis. 2014. 1 (3). ofu107.

An H.S., Seldomridge J.A. Spinal infections: diagnostic tests and imaging studies. Clin. Orthop. Relat. Res. 2006. 444. P. 27­33.

Tins B.J., Cassar­Pullicino V.N., Lalam R.K. Magnetic resonance imaging of spinal infection. Top Magn. Reson. Imaging. 2007. 18. P. 213­222.

Bettini N., Girardo M., Dema E., Cervellati S. Evaluation of conservative treatment of non­specific spondylodiscitis. Eur. Spine J. 2009. 18(Suppl. 1). P. 143­150.

Livorsi D.J., Daver N.G., Atmar R.L. et al. Outcomes of treatment for hematogenous Staphylococcus aureus vertebral osteomyelitis in the MRSA ERA. J. Infect. 2008. 57 (2). P. 128­131.

Bhavan K.P., Kirmani N. Hematogenous vertebral osteomyelitis. Mol. Med. 2009. 106 (4). P. 277­282.

Chelsom J., Solberg C.O. Vertebral osteomyelitis at a Norwegian university hospital 1987­97: clinical features, laboratory findings and outcome. Scand. J. Infect. Dis. 1998. 30 (2). P. 147­151.

Kwon J.W., Yoon Y.C., Choi S.H., Jung J.Y., Choe B.K. MR Imaging for the Differentiation of Early Infectious Spondylitis and Modic Type I Change in the Lumbar Spine. J. Korean Soc. Radiol. 2010 Jun. 62 (6). P. 563­570.

Daghighi M.H., Poureisa M., Safarpour M., Behzadmehr R., Fouladi D.F., Meshkini A. et al. Diffusion­weighted magnetic resonance imag-ing in differentiating acute infectious spondylitis from degenerative Modic type 1 change; the role of b­value, apparent diffusion coefficient, claw sign and amorphous increased signal. Br. J. Radiol. 2016. 89. 20150152


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