Are Modic changes ‘Primary infective endplatitis’?—insights from multimodal imaging of non-specific low back pain patients and development of a radiological 'Endplate infection probability score'
Purpose To probe the pathophysiological basis of Modic change (MC) by multimodal imaging rather than by MRI alone. Methods Nineteen radiological signs found in mild infections and traumatic endplate fractures were identified by MRI and CT, and by elimination, three signs unique to infection and trau...
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| Veröffentlicht in: | European spine journal 2022-11, Vol.31 (11), p.2884-2896 |
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| creator | Rajasekaran, S. Pushpa, B. T. Soundararajan, Dilip Chand Raja Sri Vijay Anand, K. S. Murugan, Chandhan Nedunchelian, Meena Kanna, Rishi Mugesh Shetty, Ajoy Prasad Tangavel, Chitraa Muthurajan, Raveendran |
| description | Purpose
To probe the pathophysiological basis of Modic change (MC) by multimodal imaging rather than by MRI alone.
Methods
Nineteen radiological signs found in mild infections and traumatic endplate fractures were identified by MRI and CT, and by elimination, three signs unique to infection and trauma were distilled. By ranking the Z score, radiological ‘Endplate Infection Probability Score’ (EIPS) was developed. The score’s ability to differentiate infection and traumatic endplate changes (EPC) was validated in a fresh set of 15 patients each, with documented infection and trauma. The EIPS, ESR, CRP, and Numeric Pain Rating Scale (NRS) were then compared between 115 patients with and 80 patients without MC.
Results
The EIPS had a confidence of 66.4%, 83% and, 100% for scores of 4, 5 and, 6, respectively, for end plate changes suggesting infection. The mean EIPS was 4.85 ± 1.94 in patients with Modic changes compared to − 0.66 ± 0.49 in patients without Modic changes (
p
|
| doi_str_mv | 10.1007/s00586-022-07335-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2699701207</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2699701207</sourcerecordid><originalsourceid>FETCH-LOGICAL-c282t-430ef26bb76394b61c4aeae4d4079d892c23568c4c446eee02ab0f8d3bef9b563</originalsourceid><addsrcrecordid>eNp9kc2O1SAYhonRxOPRG3BF4mLcVL8CpWVlJpPxJxmjC10TSr92GCkcoWfM7M5FuNBL8jbOlchYjYkLNxDI-7x84SHkcQ3PaoD2eQZoOlkBYxW0nDcVv0M2teDlqDi7SzagBFSyrdV98iDnK4C6USA35MdpQvo2Ds5Se2nChJkeD9_eJzebdENdGNEu7hophmHnzeIWl4-H7y-Oh68uZDddLpmOKc503vvFzXEwnhZ0cmGicaQhhirv0Lqx9Pv4hfbGfqI740JZFoeh4CYMdMBr9HE3l4tbzNBkBhd9nJwthSfn6-P4Z55Y8BR70zvvlhuabUx48pDcG43P-Oj3viUfX55_OHtdXbx79ebs9KKyrGNLJTjgyGTft5Ir0cvaCoMGxSCgVUOnmGW8kZ0VVgiJiMBMD2M38B5H1TeSb8nTtbeM8HmPedGzyxa9NwHjPmsmlWqhZsXDljz5J3oV9ymU6TRrOau54gJKiq0pm2LOCUe9W79f16Bv7erVri529S-7mheIr1Au4aIt_a3-D_UT1A2vSQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2732139340</pqid></control><display><type>article</type><title>Are Modic changes ‘Primary infective endplatitis’?—insights from multimodal imaging of non-specific low back pain patients and development of a radiological 'Endplate infection probability score'</title><source>SpringerNature Journals</source><creator>Rajasekaran, S. ; Pushpa, B. T. ; Soundararajan, Dilip Chand Raja ; Sri Vijay Anand, K. S. ; Murugan, Chandhan ; Nedunchelian, Meena ; Kanna, Rishi Mugesh ; Shetty, Ajoy Prasad ; Tangavel, Chitraa ; Muthurajan, Raveendran</creator><creatorcontrib>Rajasekaran, S. ; Pushpa, B. T. ; Soundararajan, Dilip Chand Raja ; Sri Vijay Anand, K. S. ; Murugan, Chandhan ; Nedunchelian, Meena ; Kanna, Rishi Mugesh ; Shetty, Ajoy Prasad ; Tangavel, Chitraa ; Muthurajan, Raveendran</creatorcontrib><description>Purpose
To probe the pathophysiological basis of Modic change (MC) by multimodal imaging rather than by MRI alone.
Methods
Nineteen radiological signs found in mild infections and traumatic endplate fractures were identified by MRI and CT, and by elimination, three signs unique to infection and trauma were distilled. By ranking the Z score, radiological ‘Endplate Infection Probability Score’ (EIPS) was developed. The score’s ability to differentiate infection and traumatic endplate changes (EPC) was validated in a fresh set of 15 patients each, with documented infection and trauma. The EIPS, ESR, CRP, and Numeric Pain Rating Scale (NRS) were then compared between 115 patients with and 80 patients without MC.
Results
The EIPS had a confidence of 66.4%, 83% and, 100% for scores of 4, 5 and, 6, respectively, for end plate changes suggesting infection. The mean EIPS was 4.85 ± 1.94 in patients with Modic changes compared to − 0.66 ± 0.49 in patients without Modic changes (
p
< 0.001). Seventy-eight (67.64%) patients with MC had a score of 6, indicating high infection possibility. There was a difference in the NRS (
p
< 0.01), ESR (
p
= 0.05), CRP (
p
< 0.01), and type of pain (
p
< 0.01) between patients with and without MC.
Conclusion
Multimodal imaging showed many radiological signs not easily seen in MRI alone and thus missed in Modic classification. There were distinct radiological differences between EPCs of trauma and infection which allowed the development of an EIPS. The scores showed that 67.64% of our study patients with Modic changes had EPCs resembling infection rather than trauma suggesting the possibility of an infective aetiology and allowing us to propose an alternate theory of ‘Primary Endplatitis’.</description><identifier>ISSN: 0940-6719</identifier><identifier>EISSN: 1432-0932</identifier><identifier>DOI: 10.1007/s00586-022-07335-3</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Computed tomography ; Fractures ; Infections ; Low back pain ; Magnetic resonance imaging ; Medicine ; Medicine & Public Health ; Neurosurgery ; Original Article ; Surgical Orthopedics ; Trauma</subject><ispartof>European spine journal, 2022-11, Vol.31 (11), p.2884-2896</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c282t-430ef26bb76394b61c4aeae4d4079d892c23568c4c446eee02ab0f8d3bef9b563</citedby><cites>FETCH-LOGICAL-c282t-430ef26bb76394b61c4aeae4d4079d892c23568c4c446eee02ab0f8d3bef9b563</cites><orcidid>0000-0002-5905-9619 ; 0000-0002-8254-3580 ; 0000-0001-5885-7152 ; 0000-0002-8885-5411 ; 0000-0002-8803-7662 ; 0000-0001-5817-4909 ; 0000-0003-4621-8892 ; 0000-0002-3061-9811 ; 0000-0001-6043-006X ; 0000-0001-8451-1729</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00586-022-07335-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00586-022-07335-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids></links><search><creatorcontrib>Rajasekaran, S.</creatorcontrib><creatorcontrib>Pushpa, B. T.</creatorcontrib><creatorcontrib>Soundararajan, Dilip Chand Raja</creatorcontrib><creatorcontrib>Sri Vijay Anand, K. S.</creatorcontrib><creatorcontrib>Murugan, Chandhan</creatorcontrib><creatorcontrib>Nedunchelian, Meena</creatorcontrib><creatorcontrib>Kanna, Rishi Mugesh</creatorcontrib><creatorcontrib>Shetty, Ajoy Prasad</creatorcontrib><creatorcontrib>Tangavel, Chitraa</creatorcontrib><creatorcontrib>Muthurajan, Raveendran</creatorcontrib><title>Are Modic changes ‘Primary infective endplatitis’?—insights from multimodal imaging of non-specific low back pain patients and development of a radiological 'Endplate infection probability score'</title><title>European spine journal</title><addtitle>Eur Spine J</addtitle><description>Purpose
To probe the pathophysiological basis of Modic change (MC) by multimodal imaging rather than by MRI alone.
Methods
Nineteen radiological signs found in mild infections and traumatic endplate fractures were identified by MRI and CT, and by elimination, three signs unique to infection and trauma were distilled. By ranking the Z score, radiological ‘Endplate Infection Probability Score’ (EIPS) was developed. The score’s ability to differentiate infection and traumatic endplate changes (EPC) was validated in a fresh set of 15 patients each, with documented infection and trauma. The EIPS, ESR, CRP, and Numeric Pain Rating Scale (NRS) were then compared between 115 patients with and 80 patients without MC.
Results
The EIPS had a confidence of 66.4%, 83% and, 100% for scores of 4, 5 and, 6, respectively, for end plate changes suggesting infection. The mean EIPS was 4.85 ± 1.94 in patients with Modic changes compared to − 0.66 ± 0.49 in patients without Modic changes (
p
< 0.001). Seventy-eight (67.64%) patients with MC had a score of 6, indicating high infection possibility. There was a difference in the NRS (
p
< 0.01), ESR (
p
= 0.05), CRP (
p
< 0.01), and type of pain (
p
< 0.01) between patients with and without MC.
Conclusion
Multimodal imaging showed many radiological signs not easily seen in MRI alone and thus missed in Modic classification. There were distinct radiological differences between EPCs of trauma and infection which allowed the development of an EIPS. The scores showed that 67.64% of our study patients with Modic changes had EPCs resembling infection rather than trauma suggesting the possibility of an infective aetiology and allowing us to propose an alternate theory of ‘Primary Endplatitis’.</description><subject>Computed tomography</subject><subject>Fractures</subject><subject>Infections</subject><subject>Low back pain</subject><subject>Magnetic resonance imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neurosurgery</subject><subject>Original Article</subject><subject>Surgical Orthopedics</subject><subject>Trauma</subject><issn>0940-6719</issn><issn>1432-0932</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kc2O1SAYhonRxOPRG3BF4mLcVL8CpWVlJpPxJxmjC10TSr92GCkcoWfM7M5FuNBL8jbOlchYjYkLNxDI-7x84SHkcQ3PaoD2eQZoOlkBYxW0nDcVv0M2teDlqDi7SzagBFSyrdV98iDnK4C6USA35MdpQvo2Ds5Se2nChJkeD9_eJzebdENdGNEu7hophmHnzeIWl4-H7y-Oh68uZDddLpmOKc503vvFzXEwnhZ0cmGicaQhhirv0Lqx9Pv4hfbGfqI740JZFoeh4CYMdMBr9HE3l4tbzNBkBhd9nJwthSfn6-P4Z55Y8BR70zvvlhuabUx48pDcG43P-Oj3viUfX55_OHtdXbx79ebs9KKyrGNLJTjgyGTft5Ir0cvaCoMGxSCgVUOnmGW8kZ0VVgiJiMBMD2M38B5H1TeSb8nTtbeM8HmPedGzyxa9NwHjPmsmlWqhZsXDljz5J3oV9ymU6TRrOau54gJKiq0pm2LOCUe9W79f16Bv7erVri529S-7mheIr1Au4aIt_a3-D_UT1A2vSQ</recordid><startdate>20221101</startdate><enddate>20221101</enddate><creator>Rajasekaran, S.</creator><creator>Pushpa, B. T.</creator><creator>Soundararajan, Dilip Chand Raja</creator><creator>Sri Vijay Anand, K. S.</creator><creator>Murugan, Chandhan</creator><creator>Nedunchelian, Meena</creator><creator>Kanna, Rishi Mugesh</creator><creator>Shetty, Ajoy Prasad</creator><creator>Tangavel, Chitraa</creator><creator>Muthurajan, Raveendran</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5905-9619</orcidid><orcidid>https://orcid.org/0000-0002-8254-3580</orcidid><orcidid>https://orcid.org/0000-0001-5885-7152</orcidid><orcidid>https://orcid.org/0000-0002-8885-5411</orcidid><orcidid>https://orcid.org/0000-0002-8803-7662</orcidid><orcidid>https://orcid.org/0000-0001-5817-4909</orcidid><orcidid>https://orcid.org/0000-0003-4621-8892</orcidid><orcidid>https://orcid.org/0000-0002-3061-9811</orcidid><orcidid>https://orcid.org/0000-0001-6043-006X</orcidid><orcidid>https://orcid.org/0000-0001-8451-1729</orcidid></search><sort><creationdate>20221101</creationdate><title>Are Modic changes ‘Primary infective endplatitis’?—insights from multimodal imaging of non-specific low back pain patients and development of a radiological 'Endplate infection probability score'</title><author>Rajasekaran, S. ; Pushpa, B. T. ; Soundararajan, Dilip Chand Raja ; Sri Vijay Anand, K. S. ; Murugan, Chandhan ; Nedunchelian, Meena ; Kanna, Rishi Mugesh ; Shetty, Ajoy Prasad ; Tangavel, Chitraa ; Muthurajan, Raveendran</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c282t-430ef26bb76394b61c4aeae4d4079d892c23568c4c446eee02ab0f8d3bef9b563</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Computed tomography</topic><topic>Fractures</topic><topic>Infections</topic><topic>Low back pain</topic><topic>Magnetic resonance imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neurosurgery</topic><topic>Original Article</topic><topic>Surgical Orthopedics</topic><topic>Trauma</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rajasekaran, S.</creatorcontrib><creatorcontrib>Pushpa, B. T.</creatorcontrib><creatorcontrib>Soundararajan, Dilip Chand Raja</creatorcontrib><creatorcontrib>Sri Vijay Anand, K. S.</creatorcontrib><creatorcontrib>Murugan, Chandhan</creatorcontrib><creatorcontrib>Nedunchelian, Meena</creatorcontrib><creatorcontrib>Kanna, Rishi Mugesh</creatorcontrib><creatorcontrib>Shetty, Ajoy Prasad</creatorcontrib><creatorcontrib>Tangavel, Chitraa</creatorcontrib><creatorcontrib>Muthurajan, Raveendran</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>European spine journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rajasekaran, S.</au><au>Pushpa, B. T.</au><au>Soundararajan, Dilip Chand Raja</au><au>Sri Vijay Anand, K. S.</au><au>Murugan, Chandhan</au><au>Nedunchelian, Meena</au><au>Kanna, Rishi Mugesh</au><au>Shetty, Ajoy Prasad</au><au>Tangavel, Chitraa</au><au>Muthurajan, Raveendran</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Are Modic changes ‘Primary infective endplatitis’?—insights from multimodal imaging of non-specific low back pain patients and development of a radiological 'Endplate infection probability score'</atitle><jtitle>European spine journal</jtitle><stitle>Eur Spine J</stitle><date>2022-11-01</date><risdate>2022</risdate><volume>31</volume><issue>11</issue><spage>2884</spage><epage>2896</epage><pages>2884-2896</pages><issn>0940-6719</issn><eissn>1432-0932</eissn><abstract>Purpose
To probe the pathophysiological basis of Modic change (MC) by multimodal imaging rather than by MRI alone.
Methods
Nineteen radiological signs found in mild infections and traumatic endplate fractures were identified by MRI and CT, and by elimination, three signs unique to infection and trauma were distilled. By ranking the Z score, radiological ‘Endplate Infection Probability Score’ (EIPS) was developed. The score’s ability to differentiate infection and traumatic endplate changes (EPC) was validated in a fresh set of 15 patients each, with documented infection and trauma. The EIPS, ESR, CRP, and Numeric Pain Rating Scale (NRS) were then compared between 115 patients with and 80 patients without MC.
Results
The EIPS had a confidence of 66.4%, 83% and, 100% for scores of 4, 5 and, 6, respectively, for end plate changes suggesting infection. The mean EIPS was 4.85 ± 1.94 in patients with Modic changes compared to − 0.66 ± 0.49 in patients without Modic changes (
p
< 0.001). Seventy-eight (67.64%) patients with MC had a score of 6, indicating high infection possibility. There was a difference in the NRS (
p
< 0.01), ESR (
p
= 0.05), CRP (
p
< 0.01), and type of pain (
p
< 0.01) between patients with and without MC.
Conclusion
Multimodal imaging showed many radiological signs not easily seen in MRI alone and thus missed in Modic classification. There were distinct radiological differences between EPCs of trauma and infection which allowed the development of an EIPS. The scores showed that 67.64% of our study patients with Modic changes had EPCs resembling infection rather than trauma suggesting the possibility of an infective aetiology and allowing us to propose an alternate theory of ‘Primary Endplatitis’.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><doi>10.1007/s00586-022-07335-3</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0002-5905-9619</orcidid><orcidid>https://orcid.org/0000-0002-8254-3580</orcidid><orcidid>https://orcid.org/0000-0001-5885-7152</orcidid><orcidid>https://orcid.org/0000-0002-8885-5411</orcidid><orcidid>https://orcid.org/0000-0002-8803-7662</orcidid><orcidid>https://orcid.org/0000-0001-5817-4909</orcidid><orcidid>https://orcid.org/0000-0003-4621-8892</orcidid><orcidid>https://orcid.org/0000-0002-3061-9811</orcidid><orcidid>https://orcid.org/0000-0001-6043-006X</orcidid><orcidid>https://orcid.org/0000-0001-8451-1729</orcidid></addata></record> |
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| source | SpringerNature Journals |
| subjects | Computed tomography Fractures Infections Low back pain Magnetic resonance imaging Medicine Medicine & Public Health Neurosurgery Original Article Surgical Orthopedics Trauma |
| title | Are Modic changes ‘Primary infective endplatitis’?—insights from multimodal imaging of non-specific low back pain patients and development of a radiological 'Endplate infection probability score' |
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