Modic Type 1 vs. Spondylodiscitis

Written by: James Demetrious, DC, DABCO

Diplomate, American Board of Chiropractic Orthopedists

A Degenerative Pain Source

MRI provides unique visualization of physiologic responses associated with spinal degeneration. Modic Type 1 changes represent inflammatory reactions of the vertebral bodies that have been associated with pain.

Modic Type 1 changes are typically visualized as hyperintense signal on T2WIs, Fat-Saturated T2WIs and hypointense on T1-weighted images. These findings are consistent with inflammation and edema that may produce pain.

Differential Assessment

Modic Type 1 changes have been termed, “aseptic spondylodiscitis.” When possible, these degenerative inflammatory changes can be differentiated from infectious spondylodiscitis.

In the differential assessment of degenerative reactive Modic Type 1 changes and septic spondylodiscitis, clinicians must consider clinical and laboratory markers of infection that may include:

  • Fever,
  • Increased
  • Increased CRP,
  • Increased ESR
  • and increased WBC levels.

In addition, the pattern of MRI findings related to septic spondylodiscitis differs as follows:

  • The IVDs adjacent to Modic Type 1 changes have decreased signal intensity compared to the high signal intensity associated with infected IVDs.
  • Modic Type 1 will have intact vertebral endplates in contrast to destroyed endplates associated with infectious spondylodiscitis.
  • Infectious spondylodiscitis may have associated phlegmon with infiltration extending into paravertebral structures.

Chiropractic Recommendations and Care

Patients who present with infective spondylodiscitis should be referred to appropriate medical providers. Chiropractic care may be beneficial for patients exhibiting aseptic Modic changes.

In their paper, Annen et al. reported that Modic positive patients who received chiropractic spinal manipulation reported higher levels of clinically relevant improvement 2 weeks, 3 and 6 months compared to Modic negative patients. [1]

References

  1. Annen et al. J Manipulative Physiol Ther. 2016;39:200-209.

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Disclosure/Disclaimer

The information provided in this article and all PostGradDC coursework should not be considered standards of care. We offer this information for educational purposes only. This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or qualified healthcare provider with any questions you may have regarding medical conditions or treatment.