Authors: Dr. P. Rishi M Kanna, Ms Ranjani Raja Reddy, Dr. Natesan Senthil, Dr. Muthuraja Raveendran,
Dr. Kenneth MC Cheung, Dr. Danny Chan, Dr Patrick YP Kao, Dr. Ajoy Prasad Shetty, Dr. S Rajasekaran.
Authors Affiliatoins: Ganga Hospital, 313, Mettupalayam Road, Coimbatore.
Address of correspondence:
Modic changes (MC) are vertebral end plate signal changes observed in sagittal magnetic resonance imaging sequences. Though the true significance of MC is not known, a significant association between non-specific low back pain and MC have been described in different studies. Recently the role of genetic factors in the etiology of MC is being evaluated by different researchers. The present study purports to evaluate the prevalence of MC and the potential role of genetic polymorphisms in 40 candidate genes (including 71 SNPs) in a large cohort.
Materials and Methods:
The study was a cross sectional study of patients presenting at the Spine Unit of a tertiary referral hospital. An individual was included in the study between the age group of 18 to 70 years, without any evidence of other spinal diseases, or history of previous lumbar spine surgery or significant spinal injury. The presence and type of Modic changes were assessed in the sagittal T1 and T2 MRI sequences. The genetic association analysis of all the potential SNPs was made with reference to the presence or absence of the presence of MC (case versus control analysis).
There were 809 individuals who satisfied the inclusion criteria, consisting of 455 males and 354 females. The mean age of the patients was 36.7 ± 10.8 years. Based on the presence of MC, the total population was divided into 702 controls and 107 cases. Among the 107 cases, 64 patients had single level MC (7.9%), 32 had double level MC (3.9%), five each had three and four level MC (0.6%) and one patient had multi-level MC. Modic changes were identified in 251 endplates among the 1070 endplates. MC was more commonly situated in the lower endplates (149, 59.4%) than in the upper endplates (102, 40.6%). L4-5 endplates were the most commonly affected level (n=77, 30.7%) followed by L5-S1 (n=66, 26.3%), L3-4 (n=60, 23.9%), L2-3 (n=31, 12.4%) and L1-2 (n=17, 6.8%).
Among the 251 endplates with MC, Type 2 MC was the most commonly observed pattern (n=206, 82%), followed by Type 1 (n=27, 10.8%) and Type 3 (n=18, 7.2%). Among the 40 candidate genes studied, the rs2228570 SNP of Vitamin D receptor (VDR) gene (p=0.02) and rs17099008 SNP of Matrix Metallo proteinase (MMP 20) (p= 0.03) were significantly associated with MC in the study population.
The significance and etiology of Modic changes are not clear but have been increasingly implicated in low back pain. Understanding the etiopathogenetic mechanisms of Modic changes is thus crucial. The present study identifies genetic polymorphisms of VDR, MMP 20, COX 2 and IGF1R to be significantly associated with MC in a large population. These associations have not been reported previously.
How to Cite this Abstract
Kumar D. Modic Vertebral Endplate changes – Prevalence, Patterns and Etiologic Genetic Association Analysis of 71 Genetic Polymorphisms in 809 patients.International Journal of Conference Proceedings. March 2015;(2015):22.