The authors declare that they have no competing interests.
MB: Reading the MRI scans; analysis and interpretation of the data; drafting of the manuscript. CKP: Reading the MRI scans; conception and design of the study; revising manuscript critically for important intellectual content; final approval of the version to be published. CWAP: Performance of imaging-guided facet injections; revising manuscript critically for important intellectual content; final approval of the version to be published; JH: Performance of imaging-guided facet injections; revising manuscript critically for important intellectual content; final approval of the version to be published; JB: Conception and design of the study; analysis and interpretation of the data; revising manuscript critically for important intellectual content; final approval of the version to be published. All authors read and approved the final manuscript.
Modic changes (MC) have been linked with low back pain (LBP) and worse outcomes from some treatments. No studies have investigated the impact that MCs may have on patient outcomes from lumbar facet injections. Therefore, the purpose of this study is to investigate whether the presence of Modic changes is related to ‘improvement’ in patients undergoing imaging-guided lumbar facet injection therapy.
Outcomes from 226 patients with MRI scans within 3 months of their imaging-guided lumbar facet injections were investigated to determine whether MCs are related to ‘improvement’ post injection. At 1 day, 1 week and 1 month post injection the Patients Global Impression of Change scale answers were collected by postal questionnaire. This was the primary outcome measure. The numerical rating scale for pain data was collected prior to treatment and at the same post injection time points. The MRI scans were independently evaluated by two examiners for the presence/absence of Modic changes and the type of Modic change if present. Kappa statistics were used for reliability of diagnosis analysis. Chi-squared test and logistic regression analysis tested MCs with ‘improvement’.
Intra- and inter-examiner reliability for the diagnosis of MCs was Kappa = 0.77 and 0.74. Intra- and inter-examiner reliability for categorizing MCs was K = 0.77 and K = 0.78.
At 1 month post injection 45.2 % of patients without MCs reported clinically relevant ‘improvement’ compared to 34.2 % of patients with MC I and 32.1 % of patients with MC II. However, this did not reach statistical significance. Logistic regression found that Modic changes were not predictive of ‘improvement’.
There was a tendency for patients without MCs to have better outcomes but this did not reach statistical significance. The reliability of diagnosing MCs was substantial.
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- Are the presence of MODIC changes on MRI scans related to “improvement” in low back pain patients treated with lumbar facet joint injections?
Cynthia K. Peterson
Christian W. A. Pfirrmann
- BioMed Central
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