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Liu B, Ding W, Wang H. Prevalence and Risk Factors for Modic Changes in Symptomatic Cervical Ossification of the Posterior Longitudinal Ligament: A Retrospective Study of 203 Patients. Med Sci Monit 2023; 29:e941674. [PMID: 37990489 PMCID: PMC10680289 DOI: 10.12659/msm.941674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Modic changes (MC) are abnormal bone signals under the vertebral endplates on magnetic resonance imaging (MRI) of the spine. Three types of MC may be seen on MRI as abnormal bone signals of the vertebral endplate and adjacent bone marrow. This retrospective study of 203 patients with symptomatic cervical ossification of the posterior longitudinal ligament (OPLL) aimed to evaluate factors associated with MC on cervical spine MRI. MATERIAL AND METHODS We included 203 patients with symptomatic cervical ossification of the OPLL. All patients underwent MRI with T1 and T2 sequences to assess the presence and type of MC. Univariate and multivariate logistic regression analyses were used to identify the risk factors for MC. RESULTS The prevalence of MC in patients with symptomatic cervical OPLL was 21.18%. Type 2 MC accounted for 88.64% of the cases. Local type and MC share the same segment (100.00%), followed by segmental type (77.27%), mixed type (75.00%), and continuous type (75.00%). Age (OR=1.05, 95% CI: 1.01-1.09, P=0.013) and neck pain (OR=2.67, 95% CI: 1.04-6.83, P=0.041) were significantly correlated with MC. Further receiver operating characteristic (ROC) analysis displayed an area under the curve (AUC) of 0.657 (P=0.002) for age, and the optimal cutoff was 60.50 years (sensitivity 0.67, specificity 0.68). CONCLUSIONS The results of this study found that older age and neck pain were significantly associated with development of cervical spine MC. Patients ≥60.5 years with symptomatic cervical OPLL had a higher probability of developing MC.
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Affiliation(s)
- Binbin Liu
- Department of Spinal Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China (mainland)
- Department of Spinal Surgery, Cangzhou Central Hospital, Cangzhou, Hebei, China (mainland)
| | - Wenyuan Ding
- Department of Spinal Surgery, Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China (mainland)
| | - Hui Wang
- Department of Spinal Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China (mainland)
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Yang F, Wang Z, Zhang H, Xie B, Zhao H, Gan L, Li T, Zhang J, Chen Z, Li T, Huang X, Chen Y, Du J. Prevalence and risk factors of occupational neck pain in Chinese male fighter pilots: a cross-sectional study based on questionnaire and cervical sagittal alignment. Front Public Health 2023; 11:1226930. [PMID: 38026361 PMCID: PMC10643867 DOI: 10.3389/fpubh.2023.1226930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Neck pain (NP) is a common musculoskeletal disorder among fighter pilots and has become a rising concern due to its detrimental impact on military combat effectiveness. The occurrence of NP is influenced by a variety of factors, but less attention has been paid to the association of NP with demographic, occupational, and cervical sagittal characteristics in this group. This study aimed to investigate the prevalence and risk factors of NP in Chinese male fighter pilots using a questionnaire and cervical sagittal measurements. Methods Demographic and flight-related data, as well as musculoskeletal pain information, were gathered from Chinese male fighter pilots via a self-report questionnaire. Cervical sagittal parameters were measured and subtypes were classified using standardized lateral cervical radiographs. Differences in various factors between the case and control groups were analyzed using t-tests or chi-square tests. Binary logistic regressions were conducted to explore potential risk factors contributing to NP. Predictors were presented as crude odds ratios (CORs) and adjusted odds ratios (AORs), along with their respective 95% confidence intervals (CIs). Results A total of 185 male fighter pilots were included in this cross-sectional study. Among them, 96 (51.9%) reported experiencing NP within the previous 12 months. The multivariate regression analysis revealed that continuous flight training (AOR: 4.695, 95% CI: 2.226-9.901, p < 0.001), shoulder pain (AOR: 11.891, 95% CI: 4.671-30.268, p < 0.001), and low back pain (AOR: 3.452, 95% CI: 1.600-7.446, p = 0.002) were significantly associated with NP. Conclusion The high 12-month prevalence of NP among Chinese male fighter pilots confirms the existence of this growing problem. Continuous flight training, shoulder pain, and low back pain have significant negative effects on pilots' neck health. Effective strategies are necessary to establish appropriate training schedules to reduce NP, and a more holistic perspective on musculoskeletal protection is needed. Given that spinal integrated balance and compensatory mechanisms may maintain individuals in a subclinical state, predicting the incidence of NP in fighter pilots based solely on sagittal characteristics in the cervical region may be inadequate.
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Affiliation(s)
- Fengyuan Yang
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
- Graduate School of Medicine, China Medical University, Shenyang, China
| | - Zhong Wang
- Department of Spine Surgery, Central Hospital of Dalian University of Technology, Dalian, China
- Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, Chongqing, China
| | - Hongxing Zhang
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
| | - Bowen Xie
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
- Air Force Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Hui Zhao
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Lu Gan
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
| | - Tengfei Li
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
| | - Jing Zhang
- Graduate School of Medicine, China Medical University, Shenyang, China
| | - Zhiqiang Chen
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
- Graduate School of Medicine, China Medical University, Shenyang, China
| | - Tianqi Li
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
- Graduate School of Medicine, China Medical University, Shenyang, China
| | - Xiaogang Huang
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
| | - Yufei Chen
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
| | - Junjie Du
- Department of Orthopedics, Air Force Medical Center of the PLA, Beijing, China
- Graduate School of Medicine, China Medical University, Shenyang, China
- Air Force Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, China
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Lambrechts MJ, Issa TZ, Toci GR, Schilken M, Canseco JA, Hilibrand AS, Schroeder GD, Vaccaro AR, Kepler CK. Modic Changes of the Cervical and Lumbar Spine and Their Effect on Neck and Back Pain: A Systematic Review and Meta-Analysis. Global Spine J 2023; 13:1405-1417. [PMID: 36448648 PMCID: PMC10416594 DOI: 10.1177/21925682221143332] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES To systematically review the current literature and perform a meta-analysis on patients with cervical or lumbar spine Modic changes to determine if their baseline axial back pain and disability are comparable to patients without Modic changes. METHODS A systematic review of the PubMed database was conducted in accordance with PRISMA guidelines. A meta-analysis was performed to compare the mean differences in back pain, leg pain, and disability based on the presence of cervical or lumbar spine Modic changes. A subgroup analysis of the different types of Modic changes was conducted to determine if Modic type affected back pain or disability. RESULTS - After review of 259 articles, 17 studies were included for meta-analysis and ten studies were included for qualitative synthesis. In the lumbar spine, 10 high-quality studies analyzed Visual Analog Scale (VAS) back pain, 10 evaluated VAS leg pain, and 8 analyzed Oswestry Disability Index. VAS back pain (mean difference (MD), -.38; 95% CI, -.61 - .16) and Oswestry disability index (MD -2.52; 95% CI, -3.93 - -1.12) were significantly lower in patients without Modic changes. Modic change subtype was not associated with differences in patient-reported outcomes. Patients with cervical spine Modic changes did not experience more severe pain than those without MC. CONCLUSIONS Modic changes in the lumbar spine are not associated with clinically significant axial low back pain severity or patient disability. Similar to the lumbar spine, Modic changes in the cervical spine are not associated with symptom severity, but they are associated with pain duration.
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Affiliation(s)
- Mark J. Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Tariq Z. Issa
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gregory R. Toci
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Meghan Schilken
- College of Medicine, Drexel University, Philadelphia, PA, USA
| | - Jose A. Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Risk Factors for Axial Symptoms After Anterior Surgery Treating for Multilevel Cervical Disorder with kyphosis. Spine (Phila Pa 1976) 2021; 46:E776-E783. [PMID: 34160369 DOI: 10.1097/brs.0000000000004086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE The aim of this study was to investigate the risk factors associated with axial symptoms (AS) after anterior surgery in treatment of multilevel cervical disorder with kyphosis based on subgroup of follow-up time. SUMMARY OF BACKGROUND DATA Although many scholars reported on AS after cervical surgery, the risk factors associated with AS are controversial. Few studies have investigated the risk factors of AS after anterior cervical surgery treating multilevel cervical disorder with kyphosis. METHODS Totally, 103 patients who suffered from multilevel cervical disorder with kyphosis receiving anterior surgery from July 2015 to June 2017 were reviewed for clinical and radiological outcomes. These data were collected at the time of before surgery, 1 week, 3 months, 6 months, 1 year, and 2 years after surgery. Data were performed to compare between the patients with and without AS. RESULTS In our study, the occurrence of AS was 46.6%, 34.0%, 20.4%, 12.6%, and 10.7% at the time of 1 week, 3 months, 6 months,1 year, and 2 years after surgery, respectively. Our findings showed that patients with smoking, disease duration, preoperative Modic changes (Mcs), post-operative Cobb angle of C2-7, cervical range of motion (ROM) and T1 slope, and change of Cobb angle of C2-7, cervical ROM and T1 slope were associated with AS within 1 year after surgery. However, patients with smoking and preoperative Mcs were found to be risk factors associated with AS at at any follow-up. CONCLUSION In the present study, many factors were related to AS during 1-year after surgery. What's more, patients with smoking and preoperative Mcs were associated with AS at any follow-up. We hope this article can provide a reference for spinal surgeons to predict which patients were susceptible to suffer from AS after anterior surgery in treatment of multilevel cervical disorder with kyphosis.Level of Evidence: 3.
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Kitiş S, Çevik S, Kaplan A, Yılmaz H, Katar S, Cömert S, Ünsal ÜÜ. Relationship Between Degeneration or Sagittal Balance With Modic Changes in the Cervical Spine. Cureus 2021; 13:e12949. [PMID: 33527064 PMCID: PMC7842237 DOI: 10.7759/cureus.12949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: This study evaluates the relationship between degenerative and Modic changes (MCs) in the cervical spine and compares the results with the cervical sagittal balance parameters. Methods: We retrospectively reviewed 275 patients with neck pain who applied to our outpatient clinic and underwent cervical magnetic resonance imaging (MRI) and cervical anteroposterior (AP)/lateral (Lat) X-ray radiography between January 2016 and January 2018. The clinics, demographic information, and radiological findings of the patients were examined. Modic changes, disc degeneration, and facet degeneration (FD) were examined by cervical MRI, and T1 slope and Cobb angle were measured by cervical AP/Lat X-ray radiography. These results were compared to evaluate their relations with each other. Results: No relationship between the presence or absence of degenerative changes (Modic changes, facet degeneration, and disc degeneration) and sagittal balance parameters (T1 slope and Cobb angle) was found. However, when each cervical segment was examined separately, facet degeneration at the C4-C5 level and Modic changes at the C3-C4, C4-C5, and C6-C7 levels were statistically significant with the Cobb angles, and the Modic changes at the C3-C4 level and disc degeneration at the C2-C3 level were found to be significant with T1 slope values. Conclusions: Our findings indicate that MCs increased with decreased cervical curvature, increasing disc and facet degeneration, although the causal mechanisms are not clear.
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Affiliation(s)
- Serkan Kitiş
- Neurosurgery, Bezmialem University, Istanbul, TUR
| | - Serdar Çevik
- Neurosurgery, Memorial Şişli Hospital, Istanbul, TUR.,School of Health Sciences, Gelişim University, Istanbul, TUR
| | - Atilla Kaplan
- Department of Radiology, Yalova State Hospital, Yalova, TUR
| | | | - Salim Katar
- Department of Neurosurgery, Balıkesir Üniversitesi, Balıkesir, TUR
| | - Serhat Cömert
- Department of Neurosurgery, Yenimahalle Training and Research Hospital, Ankara, TUR
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Association between Modic changes, disc degeneration, and neck pain in the cervical spine: a systematic review of literature. Spine J 2020; 20:754-764. [PMID: 31731008 DOI: 10.1016/j.spinee.2019.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/05/2019] [Accepted: 11/08/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND The contribution of Modic changes (MCs) in relation to spinal pain and degenerative changes has been evaluated frequently. However, most studies focus on lumbar spine. The association between MCs, neck pain, and cervical disc degeneration is not clear. PURPOSE The objective of this study was to review current literature on the association between MCs, cervical disc degeneration, and neck pain. STUDY DESIGN A systematic review METHODS: A literature search was performed in PubMed, Embase, and Web of Science using a sensitive search string combination. Studies were selected by predefined selection criteria and risk of bias was assessed using a validated Cochrane Checklist adjusted for this purpose. RESULTS Fourteen articles that associated MCs with neck pain and/or cervical disc degeneration were included in the present study. Ten articles showed low risk of bias and four showed intermediate risk of bias. The prevalence of MCs in cervical spine varied from 5% to 40% and type II was predominant. Patients with MCs were reported to experience more neck pain and disability. Cervical disc degeneration was detected more frequently in patients with MCs. CONCLUSIONS Modic changes were found to be associated with neck pain and with disc degeneration. Therefore, the large variation in prevalence that is reported is highly dependent on the nature of the studied population.
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Farrell SF, Smith AD, Hancock MJ, Webb AL, Sterling M. Cervical spine findings on MRI in people with neck pain compared with pain‐free controls: A systematic review and meta‐analysis. J Magn Reson Imaging 2019; 49:1638-1654. [DOI: 10.1002/jmri.26567] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 09/16/2018] [Accepted: 09/18/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Scott F. Farrell
- RECOVER Injury Research Centre, NHMRC Centre for Research Excellence in Recovery Following Road Traffic Injuries University of Queensland Brisbane Australia
- Menzies Health Institute Queensland Griffith University Gold Coast Australia
| | - Ashley D. Smith
- School of Allied Health Sciences Griffith University Gold Coast Australia
| | - Mark J. Hancock
- Discipline of Physiotherapy, Faculty of Medicine and Health Sciences Macquarie University Sydney Australia
| | - Alexandra L. Webb
- Medical School, College of Health and Medicine Australian National University Canberra Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre for Research Excellence in Recovery Following Road Traffic Injuries University of Queensland Brisbane Australia
- Menzies Health Institute Queensland Griffith University Gold Coast Australia
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