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Meta-Analysis
. 2018 Aug 1;13(8):e0200677.
doi: 10.1371/journal.pone.0200677. eCollection 2018.

Modic changes-Their associations with low back pain and activity limitation: A systematic literature review and meta-analysis

Christofer Herlin  1 , Per Kjaer  2 , Ansgar Espeland  3   4 , Jan Sture Skouen  5   6 , Charlotte Leboeuf-Yde  7   8 , Jaro Karppinen  9   10   11 , Jaakko Niinimäki  10   12 , Joan Solgaard Sørensen  13 , Kjersti Storheim  14   15 , Tue Secher Jensen  7   8   16
Affiliations
Meta-Analysis

Modic changes-Their associations with low back pain and activity limitation: A systematic literature review and meta-analysis

Christofer Herlin et al. PLoS One. .

Abstract

Background: Previous systematic reviews have reported positive associations between Modic changes (MCs) and low back pain (LBP), but due to their narrow scope and new primary studies, there is a need for a comprehensive systematic review. Our objectives were to investigate if MCs are associated with non-specific LBP and/or activity limitation and if such associations are modified by other factors.

Methods: A protocol for this review was registered at PROSPERO prior to commencing the work (PROSPERO record: CRD42015017350). The MEDLINE, CINAHL and EMBASE databases were searched for relevant studies from first record to June 15th 2016. Prospective or retrospective cross-sectional cohort studies and case-control studies including people of all ages from general, working and clinical study populations were eligible for inclusion. Risk of bias assessment and data extraction for associations and potential modifiers were completed independently by pairs of reviewers. Meta-analysis was performed for homogeneous studies and presented as odds ratios (OR) with 95% CI.

Results: In all, 5210 citations were identified and 31 studies were included. One study had low risk of bias. Fifteen studies (48%) reported statistically significant positive associations between MCs and LBP and one study found a statistically significant negative association. Meta-analysis performed for studies using concordant pain with provocative discography as the clinical outcome resulted in an OR of 4.01 (1.52-10.61). One of seven studies reported a statistically significant positive association between MCs and activity limitation. Lumbar disc level and disc degeneration were found to modify the association between MCs and LBP.

Conclusions: The results from this comprehensive systematic review indicate that the associations between MCs and LBP-related outcomes are inconsistent. The high risk of bias and the heterogeneity in terms of study samples, clinical outcomes and prevalence estimates of MCs and LBP may explain these findings. It is likely that new studies with low risk of bias will affect the direction and strength of these associations.

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Conflict of interest statement

These authors have declared that no competing interests exist: CH, PK, AE, JStS, CLY, JN, JSoS, KS, TSJ. JK: Paid lectures by MSD and Pfizer, Stocks of Orion Pharma Ltd, Membership of Scientific Advisory Board of Axsome Therapeutics Inc.

Figures

Fig 1
Fig 1
Modic changes on T1- (left) and T2-weighted (right) images from a 1.5 Tesla MRI scanner. (A) Modic changes type 1 at level L5-S1 (B) Modic changes type 2 at level L5-S1 (C) Modic changes type 3 at level L4-L5.
Fig 2
Fig 2. Flow diagram of study selection.
See this image and copyright information in PMC

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