To confirm that a patient has vertebrogenic pain, physicians use MRI to look for specific changes that occur with endplate inflammation, which are called Modic changes.
They’re called “Modic changes” because in 1988, Dr. Michael Modic was the first to publish on identifying and classifying degenerative endplate and marrow changes surrounding a dehydrated intervertebral disc. There were three types of bone marrow changes identified: Types 1, 2 and 3. Types 1 and 2 are the ones that can be used to identify vertebrogenic pain.
Modic Type 1
Normal bone contains trabeculae, or internal scaffolding. In the spaces between the trabeculae there is red bone marrow, which produces blood cells. In Modic Type 1 changes, you see:
- Vascular development in the vertebral body
- Findings of inflammation and edema
- NO trabecular damage or marrow changes
Modic Type 2
Normal bone contains trabeculae, or internal scaffolding. In the spaces between the trabeculae there is red bone marrow, which produces blood cells. In Modic Type 2 changes, you see:
- Changes in bone marrow
- Fatty replacement of formally red cellular marrow
- Marrow is substituted with visceral fat
- Same fat located on hips and bellies