One cause of low back pain arises when the end of a spinal vertebra is inflamed. In many cases, if correctly diagnosed, this condition can be treated effectively. But it is often overlooked – particularly when imaging isn’t used to detect Modic changes.
What are Modic changes? They are degenerative changes in the end plates of your spinal vertebrae. We’ll review them so that you can discuss them effectively with your provider.
First, a Quick Review of Spinal Anatomy for Context
If you are suffering from back pain, you are already familiar with the anatomy of your spine. Two of the primary components are vertebrae and intervertebral discs.
The spine consists of 33 individual bones known as vertebrae. They are stacked on top of each other, forming a column. At the ends of each vertebra are junctions known as vertebral endplates.
In between each pair of vertebrae are discs. These are soft, spongy pads of cartilage that cushion the vertebrae and absorb shock. A disc is between each pair of stacked vertebrae along the spine column.
Ligaments help connect the vertebrae and stabilize the spine. Numerous muscles surround the spine, providing support and enabling it to move.
Our intervertebral discs will degenerate as we age, a condition called degenerative disc disease. The rate of this degeneration varies from individual to individual. But the degeneration, in itself, doesn’t necessarily lead to back pain. Instead, back pain is often a result of other conditions caused by degeneration.
Modic Changes
“Modic changes” are so named because they were first identified by Dr. Michael Modic in 1988. The endplates of vertebrae will sometimes degenerate, leading to inflammation and pain. Dr. Modic noted that when the endplate of a vertebrae degenerated against a dehydrated interverbal disc, bone marrow would change in 1 of 3 different ways. Knowing which of the three ways is crucial as it dictates the appropriate path for treatment.
Dr. Modic classified these bone marrow changes into three types: Types 1, 2 and 3.
- Type 1 involves inflammation and edema. Edema is a condition in which excess fluid accumulates in the body’s tissues, resulting in swelling.
- Type 2 involves fatty infiltration. Fatty infiltration, also known as steatosis, refers to the abnormal accumulation of fat within tissues.
- Type 3 involves sclerotic change and endplate thickening.
Vertebrogenic Low Back Pain
Vertebrogenic low back pain is a type of chronic pain originating from damaged vertebral endplates, the interface between the disc and the vertebral body, which is often caused by wear and tear.
There is an effective treatment for this type of back pain, but it must be diagnosed correctly first. How do doctors do that? An MRI can reveal to them if Modic changes are occurring in the spine and which Type of Modic change is involved.
If it is Modic Type 1 or 2, then it indicates vertebrogenic back pain.
Treating Vertebrogenic Low Back Pain
One treatment for vertebrogenic low back pain involves a new procedure called Intracept.
As we’ve discussed, when a vertebral endplate is damaged, it can cause inflammation and pain. The basivertebral nerve, found within the vertebrae, carries these back-pain signals from the inflamed endplates to the brain.
Intracept is a minimally invasive procedure that uses a radiofrequency probe to heat the basivertebral nerve, thereby preventing it from sending pain signals to the brain. Patients are under anesthesia, and the procedure generally lasts an hour. It is an outpatient procedure.
Unlike other nerves in the body that regenerate, the basivertebral nerve has not demonstrated the ability to grow back as a pain-transmitting nerve following the Intracept Procedure.
If you are experiencing lower back pain, it may be advisable to consult your healthcare provider to determine if a Modic change assessment is appropriate in your case.