Are modic changes associated with intervertebral disc cytokine profiles?

Abstract Summary of Background Data Degenerative changes including Modic Changes (MCs) are commonly observed in patients with chronic low back pain. Although intervertebral disc (IVD) cytokine expression has been shown to be associated with low back pain, the cytokine profile for degenerative IVD with and without MC has not been compared. Purpose To evaluate the potential association between intervertebral disc cytokine expression and MCs. Study Design Laboratory Study Methods The IVD from ten patients with Type II MCs and ten patients without MCs who underwent an anterior lumbar interbody and fusion for significant low back pain were collected. The expression levels of 42 cytokines were determined using a RayBio Human Antibody Array C3 and the results were verified with Enzyme-Linked Immunosorbent Assay (ELISA). Results The cytokine array demonstrated a statistically significant increase in the expression of granulocyte-macrophage colony-stimulating factor (GM-CSF) (p = 0.001) and ENA-78 (p = 0.04), and a trend towards an increase in interleukin-1β (IL-1β) (p = 0.12) and tumor necrosis factor-α (TNF-α) (p = 0.22) in IVDs associated with Type II MCs. These results were validated with ELISA which demonstrated a 3.85 fold increase in the GM-CSF level between IVDs with Type II MCs compared to those without MCs (p = 0.03). Similarly there was a significant increase in the level of both ENA-78 (3.68 fold, p = 0.02) and IL-1β (2.11 fold, p = 0.01) in IVDs with Type II MCs. Lastly, there was a trend (p = 0.07) towards an increase in TNF-α in IVDs with Type II MCs (4.4 fold). Conclusion Intervertebral discs with Type II MCs demonstrate a significant increase in IL-1β, GM-CSF and ENA-78, and there is a trend towards an increase in TNF-α. These results further strengthen the association between MCs and low back pain.