Reactive endplate marrow changes: a systematic morphologic and epidemiologic evaluation

Purpose: To evaluate the morphology and location of vertebral endplate changes, and to analyze their association with age, gender, and body mass index (BMI). Design and patients: At 1.5 T (T1-weighted, T2-weighted/STIR) 100 lumbar spines were evaluated separately by three observers. The readers classified the endplate bone marrow abnormalities on sagittal MR images according to the definitions of Modic et al. Findings were localized by disc segment; whether in the upper and/or lower endplate; and within each endplate divided into 15 segments. Disc space narrowing, as well as disc desiccation, was also noted at each vertebral level. In addition, endplate changes were correlated with age, gender, and BMI (weight(kg)/height(m)(2)). Results: A total of 15,000 data points were studied and 422 total changes recorded. A total of 99 vertebral levels were affected in 58 patients. Of these, 171 were of type I, 242 were of type II, and 9 were of type III. L4 - L5 and L5 - S1 vertebral levels were most commonly involved, having (142, 4.73%) and (116, 3.87%) changes respectively (P< 0.0001). The upper and lower aspects of the endplate were affected similarly. Changes most frequently occurred at the anterior aspect of the endplate (P< 0.0001). Endplate marrow changes were associated with increasing age (P< 0.0001) and, surprisingly, male gender (P< 0.0001). Endplate changes were not associated with BMI. Conclusion: The fatty pattern was most common, with the sclerotic pattern being rare. Endplate marrow changes most often occurred at the anterior aspect of the endplate, particularly at L4 - L5 and L5 - S1 levels. Modic changes occur more frequently with aging, evidence of their degenerative etiology. They were, however, not related to body habitus, but to weight and male gender.