Probably mechanical overload due to the absence of cushioning effect from the disc.

This will create microfractures of the endplates, which would lead to reaction by bone edema, followed by hyperostosis and fat degeneration

Hey, Dr Kelekis,

While microfractures may be a main cause of Modic changes, some papers have indicated other factors such as anaerobic infections are closely linked with this phenomenon. Maybe this infection is caused by microfractures or something else.

I think more work can be done to reveal this. Thanks.

I agree,

Although this is based on that single paper about long term antibiotic treatment in DDD... The presence of an iflamation is most probable..The cause of the inflamation is still to be determined...

Modic is the ongoing degenerative change of the endplates following age of the discs. In this year is was hypothesized that some of Modic-changes are due to bacterial infection.

There is no strong correlation between symptoms (pain) and Modic-changes.

Hi, Dr. Marcus Schiltenwolf

I have a simliar pespective with you. Modic change seems a hint in diagnose and pathology change rather than symtom relating. Maybe a auto-immune reaction caused by elements in the disc, especially in the nucleus pulposus, is also a leading factor.

Well, all men get older, their discs as well, the endplates react.

I think Modic changes in MRI-pictures are characterized by a high sensitivity and unfortunately, by a low specificity. They do not contribute a lot to the correct diagnosing in patients with back pain. So in similar cases one should rely on a wide range of other work-up tests (clinical and paraclinical).

To Dr. Duntsch: You state that MC on MRI are a common phenomenon "linked with low back pain". Is that always so ? I think there are patients with MC who are absolutely symptomless. On the other hand, you are right that "the etiology of MC remains poorly understood" . The clinical significance of MC is not clear.