University of Oulu

Herlin C, Kjaer P, Espeland A, Skouen JS, Leboeuf-Yde C, Karppinen J, et al. (2018) Modic changes—Their associations with low back pain and activity limitation: A systematic literature review and meta-analysis. PLoS ONE 13(8): e0200677.

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

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Author: Herlin, Christofer1; Kjaer, Per2; Espeland, Ansgar3,4;
Organizations: 1Kiropraktor Kliniken Laurin, Malmö, Sweden
2Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
3Department of Radiology, Haukeland University Hospital, Bergen, Norway
4Department of Clinical Medicine, University of Bergen, Bergen, Norway
5Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
6Department of Global Public Health and Primary Care, University of Bergen, Norway
7The Spine Center of Southern Denmark, Hospital Lillebælt, Middelfart, Denmark
8Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
9Center for Life Course Health Research, University of Oulu, Oulu, Finland
10Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
11Finnish Institute of Occupational Health, Oulu, Finland
12Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
13University of Southern Denmark, Odense, Denmark
14Communication and Research Unit for Musculoskeletal Disorders (FORMI), Oslo University Hospital, Ullevål, Norway
15Faculty of Medicine, University of Oslo, Norway
16Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 3.5 MB)
Persistent link:
Language: English
Published: Public Library of Science, 2018
Publish Date: 2019-11-04


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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Series: PLoS one
ISSN: 1932-6203
ISSN-E: 1932-6203
ISSN-L: 1932-6203
Volume: 13
Issue: 8
Article number: E0200677
DOI: 10.1371/journal.pone.0200677
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: CH: The study was funded by a grant from the research foundation “ELIB – et liv I bevegelse” (Org-nr. 89777146), Website: TSJ: Salary funded by grants from the Foundation for Chiropractic Research and Post Graduate Education ( 26846/13 and 48074/12) Website: The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright information: © 2018 Herlin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.