Modic changes in the cervical spine: Prospective 20-year follow-up study in asymptomatic subjects

Abstract Background Few studies have characterized the development of Modic changesin the cervical spine over time. We evaluated Modic changesof the cervical spine that developed over a 20-year period in a healthy cohort, and sought to clarify the relationship between Modic changesand the development of clinical symptoms. Methods For this multicenter prospective cohort study, we recruited 193 subjects from an original cohort of asymptomatic volunteers who underwent MRI of the cervical spine between 1993 and 1996. Each cervical level from C2/3 to C7/T1 (total n = 1158 intervertebral levels) was assessed on current MRIs as normal or showing type 1, 2, or 3 Modic change, and we asked about symptoms related to the cervical spine. Relationships between the presence of Modic changesand patient characteristics, pre-existingdisc degenerations or clinical symptoms were evaluated by logistic regression analysis. Results After 20-year follow-up, Modic changesaffected 31 subjects (16.1%) at 47 intervertebral disclevels. Of these 47 intervertebral disclevels, type 2, found at 30 levels (63.8%), was the most frequent, followed by type 1 at 15 levels (31.9%) and type 3 at two levels (4.3%). The most frequent changes were observed at the C5/6 segment with type 2 Modic changes. The presence of Modic changescorrelated with pre-existingposterior disc protrusion(odds ratio 3.31, 95% confidence interval 1.21–9.05) and neck pain(odds ratio 2.71, 95% confidence interval 1.08–6.80). Conclusions In the cervical spine over a 20-year period, type 2 Modic changeswere most frequent at the C5/6 segment. The Modic changeswere associated with pre-existingdisc degeneration and neck painbut not with age, BMI, smoking, shoulder stiffness, arm pain or numbness.