Modic changes in the lumbar spine: Exploring their association with abdominal aortic calcification as a potential indicator of systemic atherosclerosis.

STUDY DESIGN: Cross-sectional study on the correlation between abdominal aortic calcification (AAC) and Modic changes (MC).

OBJECTIVE: To investigate whether AAC, a marker for a poor vascular status, is associated with MC in patients suffering from degenerative disc disease.

SUMMARY OF BACKGROUND DATA: Little is known regarding the etiology of MC in the lumbar spine. Currently, insufficient vascularization of the endplate has been proposed to contribute to the appearance of MC.

METHODS: Radiological images of patients (n=130) suffering from degenerative lumbar disc disease were reviewed. Type and severity of MC were assessed using MR images, and severity of AAC was evaluated using CT images or fluoroscopy. Both items were dichotomized into minimal and relevant grades. The correlation between them was studied using Spearman's correlation test, with age as a covariate.

RESULTS: Of the patients, 113 (87%) demonstrated MC (31% type I, 63% type II, and 6% type III) (55% relevant grade), and 68% had AAC (44% relevant grade). Spearman statistical analysis revealed that AAC was correlated with age (p<0.001), whereas MC were not (p=0.142). AAC severity was significantly correlated with MC, remaining so after age adjustment (p<0.05). While MC type I lacked correlation with AAC, MC type II were significantly correlated with AAC (0.288, P=0.015); however, this association lost significance after adjusting for age (P=0.057).

CONCLUSION: AAC and MC (mainly MC type II) are associated, indicating that reduced blood supply or even a poor systemic vascularization status due to atherosclerotic disease may play a role in the formation of MC. Future studies focusing on the etiology of MC should pay more attention to patients' vascular status and determinants of abdominal aorta calcification.