Have you seen the word Modic in your MRI report? It describes changes near the vertebral endplates, the areas bordering the disc. Choosing treatment requires an understanding of the whole picture: where it hurts, how symptoms change, and what examination and the complete images show.[2]
What Modic types 1, 2 and 3 mean
These are types of MRI signal from the bone marrow next to the endplates. They describe the tissue appearance on images, not the degree of pain.
- Modic 1: oedema-like and fibrovascular changes, involving increased fluid content and tissue remodelling.
- Modic 2: fatty replacement of the bone marrow near the endplates.
- Modic 3: sclerotic changes — increased bone density.
Mixed types are possible. MRI sequences and scanning conditions matter when comparing images properly.[2][3]
What the 2015 study found
Järvinen and colleagues compared MRI changes with symptoms in 64 patients with chronic lower back pain and Modic 1 or mixed Modic 1/2 changes over two years. They assessed pain and everyday limitations using the ODI score.
After adjustment for age, sex and the initial size of the changes, change in the extent of Modic 1 remained associated with change in ODI, but its relationship with changes in pain was no longer statistically significant. No significant association with symptom changes was found for Modic 2.[1]
This was an observation in a specifically selected group. Patients with nerve compression and stenosis were excluded, so the findings cannot automatically be applied to those situations.
How to interpret the relationship between MRI and pain
Modic 1 may be part of the clinical picture, but its area on MRI is not a personal “pain meter”. Modic 2 also does not necessarily mean that a person has no symptoms.
During a consultation, we discuss the nature and location of pain, its duration, its effect on movement and previous treatment results. MRI helps assess the anatomy; symptoms and examination show how these changes affect you. The significance of a finding depends on the combination of this information.[3]
How we plan treatment and when we discuss endoscopy
Modic changes affect the area near the endplates. Disc herniation and stenosis describe other anatomical changes; we assess separately whether the nerve structures are compressed.
If compression matches the symptoms and non-surgical treatment has not improved pain or function, decompression may be discussed. A mention of Modic changes in the report alone does not establish an indication for surgery.[4]
My specialisation is endoscopic spine surgery. At the consultation, we identify the aim of surgery and the possibilities of an endoscopic approach based on the cause of your symptoms.
Endoscopic removal of a lumbar disc herniation · Endoscopic decompression for lumbar stenosis
What to prepare for your consultation
- Your complete existing MRI study in DICOM format: all image series and the report. If previous studies are available, include them with dates.
- A description of symptoms: where it hurts, whether pain travels into a leg, whether there is numbness or weakness, and what has changed in walking and work.
- Treatment history: medication, exercises, injections or previous operations and their effects.
- Your question: what in the report concerns you and what treatment has already been proposed.
Send the materials you already have. We clarify the need for further investigations after review; you do not automatically need to repeat an MRI simply because Modic changes are mentioned.
When urgent assessment is needed
New urinary retention, loss of bladder or bowel control, saddle numbness or increasing leg weakness require emergency medical assessment. Do not wait for a routine consultation in a messenger.[5]
Discuss your scans with Professor Iakiv Fishchenko
Does lower back pain interfere with everyday life, while your MRI report leaves questions? Send the professor the complete images and a brief treatment history. Discuss what the findings mean, surgical options and the next step. Preliminary review of materials is free.
Send your scans to Professor Fishchenko
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Medical sources
- Järvinen J and colleagues. BMC Musculoskeletal Disorders. 2015;16:98. PubMed · DOI: 10.1186/s12891-015-0540-3. Study published on 22 April 2015.
- Modic MT and colleagues, 1988: MRI and vertebral bone marrow changes.
- ISSLS, 2019: definition, classification and description of Modic changes on MRI.
- NICE NG59: clinical assessment, imaging and indications for decompression.
- NHS: symptoms requiring emergency care.