Role of growth plate (apophyseal ring fracture) in causing modic type changes in pediatric low back pain patients

• Published in: European spine journal Vol. 30; no. 9; pp. 2565 - 2569
• Main Authors: Manabe, Hiroaki, Sakai, Toshinori, Omichi, Yasuyuki, Sugiura, Kosuke, Morimoto, Masatoshi, Tezuka, Fumitake, Yamashita, Kazuta, Takata, Yoichiro, Maeda, Toru, Sairyo, Koichi
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-09-2021; Springer Nature B.V
• Subjects: Cross-sectional studies; Degeneration; Degenerative disc disease; Fractures; Growth plate; Intervertebral discs; Low back pain; Magnetic resonance imaging; Medicine; Medicine & Public Health; Neurosurgery; Original Article; Patients; Pediatrics; Spondylolisthesis; Subchondral bone; Surgical Orthopedics; Vertebrae; Modic changes; Pediatric patients; Low back pain; Apophyseal ring fracture
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-021-06885-2

Purpose
We investigated the prevalence of Modic changes (MCs) and associated pathologies in pediatric patients.
Methods
A total of 368 MRI obtained for 240 male and 128 female patients under the age of 18 years with complaints of low back/leg pain were retrospectively examined. All changes in signal intensity in the vertebral endplate and subchondral bone on MRI were defined as MCs. We investigated the relationship between MCs and underlying diseases, including lumbar spondylolysis/spondylolisthesis, and conditions of the growth plate in cases with MCs. The degree of disc degeneration in patients with MCs was evaluated using the Pfirrmann grading system.
Results
MCs were identified in six patients (1.6%). In five of the six patients, the signal intensity changes were localized to the anterosuperior endplate of the affected vertebra; the MCs were associated with anterior apophyseal ring fracture and an open growth plate in all these cases. Disc degeneration was classified as Pfirrmann grade I in three patients and grade II and III in one patient each. One patient had type I changes associated with grade IV disc degeneration and herniation and no sign of an open growth plate.
Conclusion
The prevalence of MCs in pediatrics patients was much lower than the rates reported in adults. Most MCs were associated with an anterior apophyseal ring fracture. If Modic type changes are seen in immature vertebrae of pediatric patients, growth plate lesions such as apophyseal ring fractures should be considered.
Level of evidence
Diagnostic: individual l cross-sectional studies with consistently applied reference standard and blinding.