If you have chronic low back pain, your doctor may recommend an MRI to look more closely at your spine. When you receive the MRI report, you may see a term you have never heard before: Modic changes.
Modic changes describe certain findings in the bone marrow near the vertebral endplates. They are commonly seen on lumbar MRI scans and may be associated with some types of chronic low back pain, including vertebrogenic low back pain.
However, finding Modic changes on an MRI does not automatically mean they are the cause of your pain or that you need a specific treatment. Your symptoms, physical examination, medical history, and imaging all need to be considered together.
At DFW Sports Medicine, patients in McKinney and Frisco, Texas, can receive an evaluation to help determine whether Modic changes or another spinal condition may be contributing to their back pain and which treatment options may be appropriate.
What Are Modic Changes?
Your spine consists of individual bones called vertebrae. Between the vertebrae are discs that help cushion the spine and absorb forces during everyday activities.
Each disc sits next to a vertebral endplate. These endplates form the interface between the disc and the vertebral bone.
Changes can develop in the bone marrow near these endplates over time. When these changes have a particular appearance on an MRI, they are commonly described as Modic changes.
Modic changes are not a disease by themselves. They are an imaging finding that can occur as part of degenerative changes in the spine.
For more information about conditions affecting the spine, see our spine pain and injuries page.
What Are the Different Types of Modic Changes?
Radiologists generally classify Modic changes into several types based on how the affected area appears on MRI.
Modic Type 1
Modic Type 1 changes are associated with inflammatory and fluid-related changes in the bone marrow near the vertebral endplate.
On an MRI, these areas have a characteristic appearance related to increased water content and inflammation.
Some studies have found an association between Modic Type 1 changes and low back pain. However, the presence of these findings does not prove that they are responsible for a patient’s symptoms.
Modic Type 2
Modic Type 2 changes involve replacement of some normal bone marrow with fatty tissue.
These changes can represent a different stage of the degenerative process and may persist or develop over time.
Like Type 1 changes, Modic Type 2 findings can be associated with chronic low back pain in some patients, but they can also occur in people who do not have significant symptoms.
Modic Type 3
Modic Type 3 changes are less common. They are associated with sclerosis, or increased bone density, in the area near the vertebral endplate.
Type 3 changes are less frequently discussed in connection with vertebrogenic pain than Modic Type 1 and Type 2 changes.
Do Modic Changes Mean My Back Pain Is Coming From My Spine?
Not necessarily.
This is one of the most important things to understand when reviewing an MRI report. An imaging finding does not always explain a person’s symptoms.
Low back pain can have many potential sources, including:
- Vertebral endplates
- Intervertebral discs
- Facet joints
- Sacroiliac joints
- Spinal nerves
- Muscles and other soft tissues
A person may have Modic changes without experiencing significant back pain. Another person may have chronic pain with several abnormalities visible on an MRI.
Your physician therefore needs to compare the imaging findings with your symptoms and physical examination before determining what may be causing your pain.
What Are Modic Changes and Vertebrogenic Low Back Pain?
Modic Type 1 and Type 2 changes can be an important part of evaluating vertebrogenic low back pain.
The vertebral endplates contain nerve fibers, including the basivertebral nerve. This nerve travels within the vertebral body and can transmit pain signals from the endplate region.
When a person’s symptoms, examination, and MRI findings are consistent with vertebrogenic pain, the basivertebral nerve may be considered a potential source of chronic low back pain.
Vertebrogenic Pain vs. Sciatica
Vertebrogenic pain is different from pain caused by irritation or compression of a spinal nerve.
Sciatica or lumbar radiculopathy often causes pain that travels from the lower back or buttock into the leg and may be accompanied by numbness, tingling, or weakness.
Vertebrogenic low back pain is generally more concentrated in the lower back and is associated with pain arising from the vertebral endplate region.
This distinction is important because treatments directed toward an irritated spinal nerve may not address pain arising primarily from the vertebral endplates.
What Symptoms May Occur With Vertebrogenic Pain?
Symptoms vary from person to person, but vertebrogenic low back pain is often described as pain concentrated in the middle or lower back.
Some patients describe the pain as:
- Deep or aching
- Burning
- Persistent
- Worse with prolonged sitting
- Worse with bending forward
- Worse when lifting
- More noticeable when moving from sitting to standing
These symptoms are not specific to vertebrogenic pain. Disc problems, facet joint disorders, sacroiliac joint dysfunction, and other spinal conditions can produce similar symptoms, which is why a comprehensive evaluation is important.
How Are Modic Changes Diagnosed?
Modic changes are identified through MRI, rather than through symptoms alone.
If your MRI report mentions Modic changes, your physician may review the actual MRI images along with the radiologist’s report. The location and type of changes can be important when determining whether they may be relevant to your symptoms.
Your physician may also ask about:
- How long you have had back pain
- Where the pain is located
- Activities or positions that make it better or worse
- Whether pain travels into your legs
- Numbness, tingling, or weakness
- Previous injuries
- Medical conditions
- Treatments you have already tried
A physical examination can help evaluate spinal movement, strength, sensation, reflexes, and other potential sources of pain.
The goal is to determine whether the MRI findings and clinical picture point toward the same source.
Do Modic Changes Require Treatment?
Not necessarily.
Modic changes themselves do not always require treatment. If they are not associated with symptoms, no specific treatment may be necessary for the MRI finding.
When Modic changes appear alongside chronic low back pain, treatment depends on the suspected source of pain, severity of symptoms, and treatments that have already been attempted.
Depending on the diagnosis, treatment may include physical therapy, exercise, activity modification, medications when medically appropriate, and treatments directed at other identified sources of pain.
For appropriately selected patients with chronic vertebrogenic low back pain, a physician may also discuss basivertebral nerve ablation with the Intracept® Procedure.
What Is the Intracept Procedure?
The Intracept Procedure is a minimally invasive treatment designed to target the basivertebral nerve inside the vertebral body.
For patients whose history, physical examination, and MRI findings suggest that the vertebral endplates are the source of chronic low back pain, basivertebral nerve ablation may be considered after appropriate conservative treatment has been unsuccessful.
The procedure uses radiofrequency energy to interrupt pain signals carried by the basivertebral nerve.
Importantly, having Modic changes on an MRI does not automatically make someone a candidate for Intracept.
A physician must determine whether the patient’s symptoms, examination, medical history, previous treatment, and MRI findings are consistent with vertebrogenic low back pain and whether the patient meets appropriate criteria for the procedure.
Are Modic Changes the Same as a Herniated Disc?
No.
Modic changes involve the bone marrow near the vertebral endplates. A herniated disc occurs when material from an intervertebral disc extends beyond its normal boundaries.
These conditions can occur together, but they are different findings.
A herniated disc may irritate or compress a spinal nerve and cause symptoms such as radiating leg pain, numbness, tingling, or weakness. Modic changes may be associated with a different pattern of predominantly low back pain.
Your physician can help determine which findings on your MRI are actually relevant to your symptoms.
Frequently Asked Questions
Are Modic changes serious?
Modic changes can be part of the degenerative changes seen in the spine. Their significance depends on the individual patient. They do not automatically indicate a serious problem or mean that a procedure is necessary.
Can Modic changes cause back pain?
They may be associated with chronic low back pain in some patients, particularly when the MRI findings and clinical symptoms are consistent with vertebrogenic pain. However, Modic changes can also occur in people without significant pain.
Can Modic changes go away?
The appearance of Modic changes can change over time, and different types may develop or persist. Whether the MRI findings change does not necessarily predict how a person’s pain will behave.
Do I need treatment if my MRI shows Modic changes?
Not necessarily. Treatment decisions should be based on your symptoms, examination, medical history, imaging, and overall diagnosis rather than an MRI finding alone.
Can Modic changes be treated with Intracept?
Intracept may be considered for certain appropriately selected patients with chronic vertebrogenic low back pain and relevant MRI findings. Having Modic changes alone does not make someone a candidate.
Are epidural steroid injections used for Modic changes?
Epidural steroid injections are generally used to treat inflammation associated with irritated spinal nerves, such as certain cases of lumbar radiculopathy or sciatica. Because vertebrogenic pain involves a different potential pain source, treatment recommendations depend on identifying which structure is most likely responsible for a patient’s symptoms.
When Should You See a Physician for Back Pain?
Consider an evaluation if your back pain is persistent, recurring, worsening, or interfering with your normal activities, work, exercise, or sleep.
You should seek prompt medical attention if back pain is accompanied by new loss of bladder or bowel control, numbness around the groin or saddle area, or significant or worsening weakness in the legs.
A physician can evaluate your symptoms and determine whether an MRI or other diagnostic testing is appropriate.
Have Modic Changes on Your MRI?
Seeing terms such as Modic Type 1 or Modic Type 2 changes on an MRI report can be confusing. More importantly, the MRI finding alone cannot determine whether the vertebral endplates are actually causing your pain.
At DFW Sports Medicine, the evaluation includes reviewing your symptoms, physical examination, medical history, previous treatments, and relevant imaging to help distinguish vertebrogenic pain from other potential causes of chronic low back pain.
If the findings are consistent with vertebrogenic pain, treatment options—including whether basivertebral nerve ablation with the Intracept Procedure may be appropriate—can then be discussed.
Patients in McKinney and Frisco, Texas, can schedule an appointment at DFW Sports Medicine for evaluation of chronic low back pain and MRI findings.
This article is intended for general educational purposes and is not a substitute for medical advice. Treatment recommendations depend on an individual examination, diagnosis, medical history, and imaging findings. Individual results vary.