Degenerative Endplate Changes

KEY FACTS

Terminology

• Vertebral endplate change, Modic changes

  • Type I, II, III endplate change

• MR signal abnormalities involving vertebral body endplates related to degenerative disc disease

  • Type I: Hypointense on T1, hyperintense on T2

  • Type II: Hyperintense on T1, isointense on T2

  • Type III: Hypointense on T1 and T2

Top Differential Diagnoses

• Disc space infection

• Pseudoarthrosis/nonunion

• Seronegative spondyloarthropathy

• Metastatic disease

Pathology

• Type I: Replacement with fibrovascular marrow

• Type II: Replacement by fatty marrow

• Type III: Replacement by bony sclerosis with little residual marrow

Clinical Issues

• Type I: Present in 4% of patients undergoing MR for disc disease

• Type II: Present in 16% of patients undergoing MR for disc disease

  • Commonly present after successful segmental fusion

• Type III: Least common (∼ 1%)

• Relationship of type I endplate changes to low back pain (discogenic pain) controversial

  • Some studies suggest type I, II changes have high specificity (> 90%) but low sensitivity (20-30%) for painful lumbar disc

  • Type I change shows high positive predictive value with discography

TERMINOLOGY