University of Oulu

Udby, PM, Samartzis, D, Carreon, LY, Andersen, MØ, Karppinen, J, Modic, M. A definition and clinical grading of Modic changes. J Orthop Res. 2022; 40: 301- 307. doi:10.1002/jor.25240

A definition and clinical grading of Modic changes

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Author: Udby, Peter M.1,2; Samartzis, Dino3,4; Carreon, Leah Y.2;
Organizations: 1Spine Unit, Department of Orthopedic Surgery, Zealand University Hospital, Roskilde, Denmark
2Spine Surgery and Research, Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark
3Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
4International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, Illinois, USA
5Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
6Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
7Vanderbilt University Medical Center, Nashville, Tennessee, USA
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.4 MB)
Persistent link:
Language: English
Published: John Wiley & Sons, 2022
Publish Date: 2022-03-09


To provide an up-to-date description of knowledge and pitfalls related to the classification, definition and grading of Modic changes (MC) visualized on magnetic resonance imaging (MRI). State-of-the-art review of current knowledge regarding the definition and grading of MC on MRI. MC on MRI have been reported to be associated with low back pain and disability. However, previous studies have shown heterogeneous results in regards to the impact of MC and its clinical relevance in patients with back pain. MC is a term used with considerable variation in the literature. No strict definition has been provided previously, this has contributed to varying diagnostic inclusion criteria, heterogeneous study populations, and discrepancy in results. A definition of MC and a proposal for grading is provided in this state-of-the-art review. MC are important, clinically relevant findings. However, issues with the nomenclature, definition and grading of these changes need to be addressed. Our current review highlights relevant issues related to MC, and provides a definition and grading score for the term MC that includes the Modic type and the extent of vertebral body involvement. Future studies should seek to validate the MC grading score in clinically relevant populations.

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Series: Journal of orthopaedic research
ISSN: 0736-0266
ISSN-E: 1554-527X
ISSN-L: 0736-0266
Volume: 40
Issue: 2
Pages: 301 - 307
DOI: 10.1002/jor.25240
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © 2021 Orthopaedic Research Society. Published by Wiley Periodicals LLC. This is the peer reviewed version of the following article: Udby, PM, Samartzis, D, Carreon, LY, Andersen, MØ, Karppinen, J, Modic, M. A definition and clinical grading of Modic changes. J Orthop Res. 2022; 40: 301- 307, which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.