Prevalence and distribution of Modic Changes and association with low back pain:   a descriptive analysis

Mohamed A Shazahan; Alistair Stirling; Adrian Gardner

doi:10.1302/2633-1462.612.bjo-2025-0230.r1

Prevalence and distribution of Modic Changes and association with low back pain: a descriptive analysis

Mohamed A Shazahan, Alistair Stirling, Adrian Gardner

Research output: Contribution to journal › Article › peer-review

Abstract

Aims:
This study examines the prevalence and distribution of Modic changes (MCs) in the lumbar spine and the association with low back pain (LBP) across different age and sex categories.

Methods:
A retrospective cross-sectional analysis was conducted based on MRI data from a UK orthopaedic centre of lumbar spine MRIs from January to December 2023. Demographics and clinical presentation, namely LBP, was analyzed for correlation with the presence of MC, which was categorized as Modic type I (M1) and II (M2), according to MRI signal intensity. Prior spinal surgery or spinal deformity were exclusion criteria.

Results:
The results showed a high frequency of M1 and M2 changes at lower lumbar levels, particularly at L4/L5 and L5/S1, known to be subject to greater mechanical stresses (p < 0.001). MCs were highly correlated with LBP, as 66% of the patients had both conditions. Females were more affected with 72% of females with MC having LBP compared to 58% of males, (p < 0.001). M1 changes were also more frequently associated with LBP in young and old age groups.

Conclusion:
These results show that not only are MC a common phenomenon, but that they are correlated with the presenting complaint of LBP in confirmation of previous studies. The work presented here adds to this by documenting the anatomical location, female predominance and age distribution where the presence of MC is more highly correlated with the presenting complaint of LBP.

Original language	English
Pages (from-to)	1560-1565
Number of pages	6
Journal	Bone & Joint Open
Volume	6
Issue number	12
Early online date	8 Dec 2025
DOIs	https://doi.org/10.1302/2633-1462.612.bjo-2025-0230.r1
Publication status	Published - 8 Dec 2025

Bibliographical note

Copyright © 2025 Shazahan et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Non- Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/

Data Access Statement

The data that support the findings for this study are available to other researchers from the corresponding author upon reasonable request.

Access to Document

10.1302/2633-1462.612.bjo-2025-0230.r1Licence: CC BY-NC-ND 4.0

Prevalence and distribution of Modic Changes and association with low back pain
Copyright © 2025 Shazahan et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Non- Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/
Final published version, 458 KBLicence: CC BY-NC-ND 4.0

Cite this

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title = "Prevalence and distribution of Modic Changes and association with low back pain: a descriptive analysis",

abstract = "Aims:This study examines the prevalence and distribution of Modic changes (MCs) in the lumbar spine and the association with low back pain (LBP) across different age and sex categories.Methods:A retrospective cross-sectional analysis was conducted based on MRI data from a UK orthopaedic centre of lumbar spine MRIs from January to December 2023. Demographics and clinical presentation, namely LBP, was analyzed for correlation with the presence of MC, which was categorized as Modic type I (M1) and II (M2), according to MRI signal intensity. Prior spinal surgery or spinal deformity were exclusion criteria.Results:The results showed a high frequency of M1 and M2 changes at lower lumbar levels, particularly at L4/L5 and L5/S1, known to be subject to greater mechanical stresses (p < 0.001). MCs were highly correlated with LBP, as 66% of the patients had both conditions. Females were more affected with 72% of females with MC having LBP compared to 58% of males, (p < 0.001). M1 changes were also more frequently associated with LBP in young and old age groups.Conclusion:These results show that not only are MC a common phenomenon, but that they are correlated with the presenting complaint of LBP in confirmation of previous studies. The work presented here adds to this by documenting the anatomical location, female predominance and age distribution where the presence of MC is more highly correlated with the presenting complaint of LBP.",

author = "Shazahan, {Mohamed A} and Alistair Stirling and Adrian Gardner",

note = "Copyright {\textcopyright} 2025 Shazahan et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Non- Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/",

year = "2025",

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doi = "10.1302/2633-1462.612.bjo-2025-0230.r1",

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TY - JOUR

T1 - Prevalence and distribution of Modic Changes and association with low back pain

T2 - a descriptive analysis

AU - Shazahan, Mohamed A

AU - Stirling, Alistair

AU - Gardner, Adrian

N1 - Copyright © 2025 Shazahan et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Non- Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/

PY - 2025/12/8

Y1 - 2025/12/8

N2 - Aims:This study examines the prevalence and distribution of Modic changes (MCs) in the lumbar spine and the association with low back pain (LBP) across different age and sex categories.Methods:A retrospective cross-sectional analysis was conducted based on MRI data from a UK orthopaedic centre of lumbar spine MRIs from January to December 2023. Demographics and clinical presentation, namely LBP, was analyzed for correlation with the presence of MC, which was categorized as Modic type I (M1) and II (M2), according to MRI signal intensity. Prior spinal surgery or spinal deformity were exclusion criteria.Results:The results showed a high frequency of M1 and M2 changes at lower lumbar levels, particularly at L4/L5 and L5/S1, known to be subject to greater mechanical stresses (p < 0.001). MCs were highly correlated with LBP, as 66% of the patients had both conditions. Females were more affected with 72% of females with MC having LBP compared to 58% of males, (p < 0.001). M1 changes were also more frequently associated with LBP in young and old age groups.Conclusion:These results show that not only are MC a common phenomenon, but that they are correlated with the presenting complaint of LBP in confirmation of previous studies. The work presented here adds to this by documenting the anatomical location, female predominance and age distribution where the presence of MC is more highly correlated with the presenting complaint of LBP.

AB - Aims:This study examines the prevalence and distribution of Modic changes (MCs) in the lumbar spine and the association with low back pain (LBP) across different age and sex categories.Methods:A retrospective cross-sectional analysis was conducted based on MRI data from a UK orthopaedic centre of lumbar spine MRIs from January to December 2023. Demographics and clinical presentation, namely LBP, was analyzed for correlation with the presence of MC, which was categorized as Modic type I (M1) and II (M2), according to MRI signal intensity. Prior spinal surgery or spinal deformity were exclusion criteria.Results:The results showed a high frequency of M1 and M2 changes at lower lumbar levels, particularly at L4/L5 and L5/S1, known to be subject to greater mechanical stresses (p < 0.001). MCs were highly correlated with LBP, as 66% of the patients had both conditions. Females were more affected with 72% of females with MC having LBP compared to 58% of males, (p < 0.001). M1 changes were also more frequently associated with LBP in young and old age groups.Conclusion:These results show that not only are MC a common phenomenon, but that they are correlated with the presenting complaint of LBP in confirmation of previous studies. The work presented here adds to this by documenting the anatomical location, female predominance and age distribution where the presence of MC is more highly correlated with the presenting complaint of LBP.

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