Modic changes are signal changes in the bone marrow next to a disc, seen on MRI. They were first described as part of degenerative disc disease. Type 1 is the type most linked to back pain in younger adults, and it tends to convert to type 2 over months to years. After a car accident, a Modic change on an MRI report usually raises the question of whether it is new. The original research gives a partial answer for patients in Charlotte.
The Original Description
Modic and colleagues reviewed lumbar MRIs from 474 consecutive patients (Modic, Radiology 1988). Type 1 changes, dark on T1 images and bright on T2, were found in 4%. Type 2 changes, bright on T1 and similar or slightly bright on T2, were found in 16%. Every case had degenerative disc disease at the same level. In three cases of each type examined under a microscope, type 1 showed disrupted, fissured endplates with vascular fibrous tissue, and type 2 showed replacement of the marrow with fat.
In a small follow-up group, type 1 changes converted to type 2 in five of six patients over 14 months to 3 years. Type 2 changes in ten patients stayed stable over two to three years.
Link to Back Pain
In a meta-analysis of adults 50 or younger, Modic type 1 change was significantly more common in people with low back pain than in people without it, with an odds ratio of 4.01 (Brinjikji, AJNR 2015 meta-analysis). Modic changes considered as a group were not significantly associated with pain. The distinction between types matters.
Can a Crash Cause a Modic Change?
The 1988 study described Modic changes as part of degenerative disc disease, and it did not study trauma. I have not found evidence in these sources that a collision causes Modic changes. The radiology committee behind the standard disc nomenclature also wrote that its definitions do not imply trauma (Williams, AJNR 2014).
The conversion data offer one limited clue. Because type 1 tended to become type 2 over 14 months to 3 years in a small group, a type 1 change is more likely to be in an active phase than a stable type 2. That is not a way to date a change to a specific collision, and the follow-up group was six patients.
What I Look For
When a post-crash MRI shows a Modic change, I look for prior imaging of the same level, check whether the level matches the patient's pain on exam, and note the type. A type 1 change at a level that matches the exam is a finding worth following. It is not, on this evidence, proof of a collision injury.
For an example of how post-collision imaging findings and outcomes are documented in the peer-reviewed literature, read Dr. Justin Dick's published case report on refractory lumbar pain following a motor vehicle accident in a geriatric patient.
Frequently Asked Questions
What are Modic changes?
Modic changes are bone marrow signal changes next to a disc on MRI, described as part of degenerative disc disease (Modic, Radiology 1988).
What is the difference between Modic type 1 and type 2?
Type 1 is dark on T1 and bright on T2 and showed disrupted endplates with vascular tissue. Type 2 is bright on T1 and showed fatty marrow replacement.
Are Modic changes linked to back pain?
Type 1 was significantly more common in adults 50 or younger with low back pain, with an odds ratio of 4.01. Modic changes as a group were not significantly associated with pain (Brinjikji, AJNR 2015 meta-analysis).
Can a car accident cause Modic changes?
The original research described them as part of degenerative disc disease and did not study trauma. These sources do not show that a collision causes them.
How does Dr. Justin Dick interpret Modic changes after a crash?
Dr. Justin Dick in Charlotte, NC checks for prior imaging of the same level, whether the level matches the exam, and the Modic type.
Where can I get an MRI with Modic changes reviewed in Charlotte, NC?
Dr. Justin Dick, DC, CNMT, ARRT(N)(CT), sees car accident patients at Clear Life Scoliosis and Chiropractic Center, 8814 Rachel Freeman Way, Suite 103, Charlotte, NC 28278, phone 980-368-0766. Personal injury patients are treated on a lien basis, with no out-of-pocket payment at the time of care.
Sources and Evidence Tiers
- Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988;166(1 Pt 1):193-199. PMID 3336678. LinkEvidence tier: Retrospective imaging series (474 patients) with small histology and longitudinal subsets
- Brinjikji W, Diehn FE, Jarvik JG, et al. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2015;36(12):2394-2399. PMID 26359154. LinkEvidence tier: Systematic review and meta-analysis
- Williams AL, Murtagh FR, Rothman SLG, Sze GK. Lumbar disc nomenclature: version 2.0. AJNR Am J Neuroradiol. 2014;35(11):2029. LinkEvidence tier: Editorial by the ASSR/ASNR nomenclature committee (expert consensus)
About the author. Dr. Justin M. Dick, DC, is the owner and treating clinician at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. He holds dual imaging credentials as a Certified Nuclear Medicine Technologist (CNMT) and as an ARRT-registered technologist in nuclear medicine and CT, ARRT(N)(CT). He is a Senior Fellow of the CLEAR Institute, holds the ISICO World Masters credential, is a SOSORT provisional member, and is a certified DOT medical examiner on the FMCSA National Registry. He has multiple peer-reviewed publications indexed in PubMed and serves as adjunct faculty at Life, Sherman, and Palmer chiropractic colleges.
Service Area
Clear Life Scoliosis and Chiropractic Center sees personal injury and spinal imaging patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, and Fort Mill SC.
Related Pages
- Personal injury and car accident spinal care in Charlotte
- Dr. Justin Dick's research
- Case report: refractory lumbar pain after a motor vehicle accident
- Research and evidence at Clear Life
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8814 Rachel Freeman Way, Suite 103
Charlotte, NC 28278
Phone: 980-368-0766
Email: office@clearlifescoliosis.com
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