The Distribution Of Different Types Of Modic Changes In Patients With Low Back Pain And Its Related Factors

ObjectiveTo summarize the clinical distribution of different types of Modic changes in low back pain patients and explore the related factors.MethodWe selected 153 patients who visited the department of orthopedic surgery,first affiliated hospital of Soochow University for low back pain from January 2015 to December 2017.All of them took a lumbar Magnetic Resonance Imaging,and diagnosed with endplate Modic changes.Summarize the clinical distribution characteristics of Modic changes.record gender,age,the grade of disc degeneration,herniation,involved segments,lumbar lordosis,sacral slope,L4/5?L5/S1 segment lordosis angle,L4 lower,L5 upper and L5 lower endplate concave angle respectively.Two or more groups were divide into according to different classification of related factors to investigate the relationship between these potential factors and different types of Modic changes.We Use SPSS22.0 statistical software for data analysis,all related factors were present by count data.Chi-square test was performed to analysis the comparison of these above mentioned related factors between two different types,and the relevant factors were put into Multivariate logistic regression analysis to analyze their correlation.Results153 patients were included in the study.35 patients with type I changes,110 patients with type ? changes,and 8 patients with type III changes.The incidence rate was 22.9%,71.9%,and 5.2%,respectively.204 discs were found with Modic changes,the involved segments were: L1/2(10 discs),L2/3(18 discs),L3/4(17 discs),L4/5(76 discs),and L5/S1(81 discs).The incidence rate was 4.9%,8.8%,8.3%,37.3%,39.7%,respectively.Type I changes were distribute mainly over the age of 50 while type ? changes were distribute mainly under the age of 50.The number of patients with type ? changes was relatively small,and not included in the analysis of related factors.145 patients with type I and type II changes were included in the analysis of related factors.Multivariate regression showed that gender,age,the grade of disc degeneration,lumbar lordosis,L4/5 segment lordosis angle,L5 upper endplate concave angle was related with different type of Modic changes,P<0.05.Binary Logistic regression analysis shows that the regression equation is Y=2.410-1.361S-0.633A-0.654P+1.106L-0.990D(Y means type I changes,S means gender,A means age,P means the grade of disc degeneration,L means L4/5 segment lordosis angle,and D means L5 upper endplate concave angle.The OR values are S=0.256,A=0.531,P=0.520,L=3.022,D=0.372,respectively.Conclusion1.In low back pain patients,type ? changes are most common,followed by type I,type ? are least common.Modic changes mostly occur in L4/5 and L5/S1.2.Young,male,lower grade disc degeneration,normal physiological curvature of the lumbar spine,and normal endplate concave angle were associated with type I changes;3.Old,female,high grade disc degeneration,abnormal physiological curvature of the lumbar spine,and abnormal endplate concave angle were associated with type ? changes;4.Gender and lumbar curvature are the most relevant factors for different types.