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Vol. 62. Issue 4.
Pages 274-281 (July - August 2018)
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Vol. 62. Issue 4.
Pages 274-281 (July - August 2018)
Original Article
DOI: 10.1016/j.recote.2018.04.006
Are Modic changes in patients with chronic low back pain indicative of a worse clinical course? 10 years of follow-up
¿Supone la presencia de cambios Modic en pacientes con dolor lumbar crónico una peor evolución clínica y una mayor posibilidad de precisar cirugía? Evolución a 10 años
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L.M. Romero-Muñoza,
Corresponding author
luismadoc@gmail.com

Corresponding author.
, A. Barriga-Martína, A. Segura-Fragosob, C. Martín-Gonzálezc
a Servicio de Cirugía Ortopédica y Traumatología, Hospital Nacional de Parapléjicos, Toledo, Spain
b Servicio de Investigación, Instituto de Ciencias de la Salud, Talavera de la Reina, Toledo, Spain
c Servicio de Cirugía Ortopédica y Traumatología, Hospital Niño Jesús, Madrid, Spain
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Tables (3)
Table 1. Results obtained from study parameters at the time of the study and currently for each of the groups.
Table 2. Comparison of both groups with regard to low back pain, pain in the leg and the Oswestry disability scale in patients with/without Modic type changes in lumbar magnetic resonance at 10 years of follow-up.
Table 3. Comparison of both groups with regards to the requirement for surgical treatment, medical treatment and disability in patients with/without Modic type changes in lumbar magnetic resonance imaging at 10 years of follow-up.
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Abstract
Objective

Establish the long-term (10 years) predictive value of Modic changes in the course of lumbar pain and the need for surgical treatment.

Material and method

Observational longitudinal prospective cohort study. Comparison of progression at 10 years of 2 groups of patients with chronic lumbar pain: group A with Modic changes in MRI and group B with no Modic changes. Exclusion criteria: neoplasia, inflammatory or infectious diseases, or previous surgery. Assessment was done with the aid of the VAS for low lumbar and radicular pain and the Oswestry Disability Questionnaire. The need for surgical or medical treatment and occupational disability during the study period was analysed. For the statistical analyses, the Mann–Whitney U test and logistic regression were applied.

Results

Seventy patients, 24 male and 46 female, with a mean age of 56.5 years (35 in each group) were included in the study. No statistically significant differences in the intensity of lumbar pain, degree of impairment, or need for medical or surgical treatment (p>.05) were found in patients with Modic changes types 1, 2, or 3 between the baseline assessment and 10 years after. No statistically significant differences between patients with/without changes in Modic at 10 years of follow-up (p>.05) were determined.

Conclusions

There is no relationship between Modic changes in MRI and greater intensity of lumbar pain or need for medical or surgical treatment at 10 years of follow-up. Modic changes cannot be considered a sign of bad prognosis by themselves, or an indication for surgery.

Keywords:
Modic changes
Magnetic resonance imaging
Lumbar
Low back pain
Resumen
Objetivo

Valor de los cambios Modic a 10 años en la evolución del dolor lumbar y requerimiento quirúrgico.

Material y método

Estudio observacional longitudinal de cohortes prospectivo. Se compara la evolución a los 10 años de 2 grupos de pacientes con dolor lumbar crónico: el grupo A mostraba cambios Modic en la RM y el grupo B no tenía cambios Modic. Criterios de exclusión: neoplasia, enfermedad inflamatoria o infecciosa y cirugía previa. Fueron valorados mediante EVA para dolor lumbar, radicular y cuestionario de discapacidad de Oswestry. Se estudia la necesidad de tratamiento quirúrgico o médico y la obtención de una incapacidad laboral en el periodo de estudio. El análisis estadístico fue realizado mediante U de Mann-Whitney y regresión logística.

Resultados

Se incluyeron 70 pacientes, 24 varones y 46 mujeres, con una edad media de 56,5 años (35 en cada grupo). No se encontraron diferencias estadísticamente significativas en los pacientes con cambios Modic 1, 2 o 3 entre la valoración inicial y la realizada 10 años después en la intensidad del dolor lumbar, el grado de discapacidad o la necesidad de tratamiento médico o quirúrgico (p>0,05). No se observan diferencias estadísticamente significativas entre los pacientes con cambios Modic y sin ellos a 10 años de seguimiento (p>0,05).

Conclusión

La presencia de cambios Modic en la RM no se relaciona con una mayor intensidad del dolor, de la discapacidad por dolor lumbar o la necesidad de tratamiento médico o quirúrgico a 10 años de seguimiento. Los cambios Modic no pueden ser considerados un signo de mal pronóstico por sí solos, ni una indicación para cirugía.

Palabras clave:
Cambios Modic
Resonancia magnética
Lumbar
Dolor

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