Lumbar Degenerative Disc Disease

  • Michael T. Modic
  • Sean Symons


The sequelae of disc degeneration remain among the leading causes of functional incapacity in both men and women and are a common source of chronic disability in the working years. A significant portion of the cost of the morbidity associated with neck and back disorders is related to diagnostic testing, mostly medical imaging, the results of which may rightly or wrongly provide the basis for subsequent, more invasive treatments.


Intervertebral Disc Nucleus Pulposus Disc Herniation Disc Degeneration Spinal Stenosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Hestbaek L, Iachine IA, Leboeuf-Yde C et al (2004) Heredity of low back pain in a young population: a classical twin study. Twin Res 7:16–26PubMedCrossRefGoogle Scholar
  2. 2.
    Marini JC (2001) Genetic risk factors for lumbar disk disease. JAMA 285:1886–1888PubMedCrossRefGoogle Scholar
  3. 3.
    Modic M (2007) Degenerative disc disease: genotyping, MR imaging and phenotyping. Skeletal Radiol 36:91–93PubMedCrossRefGoogle Scholar
  4. 4.
    Annunen S, Paassilta P, Lohiniva J et al (1999) An allele of COL9A2 associated with intervertebral disc disease. Science 285:409–412PubMedCrossRefGoogle Scholar
  5. 5.
    Nelson CL, Janecki CJ, Gildenberg PL, Sava G (1972) Disk protrusions in the young. Clin Orthop Relat Res 88:142–150PubMedCrossRefGoogle Scholar
  6. 6.
    Varlotta GP, Brown MD, Kelsey JL, Golden AL (1991) Familial predisposition for herniation of a lumbar disc in patients who are less than twenty-one years old. J Bone Joint Surg Am 73:124–128PubMedGoogle Scholar
  7. 7.
    Matsui H, Terahata N, Tsuji H et al (1992) Familial predisposition and clustering for juvenile lumbar disc herniation. Spine 17:1323–1328PubMedGoogle Scholar
  8. 8.
    Scapinelli R (1993) Lumbar disc herniation in eight siblings with a positive family history for disc disease. Acta Orthop Belg 59:371–376PubMedGoogle Scholar
  9. 9.
    Quinet RJ, Hadler NM (1979) Diagnosis and treatment of backache. Semin Arthritis Rheum 8:261–287PubMedCrossRefGoogle Scholar
  10. 10.
    Bonneville JF, Dietemann JL (1992) Imaging in sciatica. Rev Prat 42:554–566PubMedGoogle Scholar
  11. 11.
    Brant-Zawadzki MN, Jensen MC, Obuchowski N, Ross JS, Modic MT (1995) Interobserver and intraobserver variability in interpretation of lumbar disc abnormalities. A comparison of two nomenclatures. Spine 20:1257–1263PubMedCrossRefGoogle Scholar
  12. 12.
    Breton G (1991) Is that a bulging disk, a small herniation or a moderate protrusion? Can Assoc Radiol J 42:318PubMedGoogle Scholar
  13. 13.
    Fardon DF, Balderston RA, Garfin SR et al (1991) Disorders of the spine, a coding system for diagnoses. Hanley and Belfus, Philadelphia, pp 20–22Google Scholar
  14. 14.
    Milette PC (2001) Reporting lumbar disk abnormalities: at last, consensus! AJNR Am J Neuroradiol 22:428–429PubMedGoogle Scholar
  15. 15.
    Czervionke LF (1993) Lumbar intervertebral disc disease. Neuroimaging Clin N Am 3:465–485Google Scholar
  16. 16.
    Modic MT, Herfkens RJ (1990) Intervertebral disk: normal age-related changes in MR signal intensity. Radiology 177:332–333PubMedGoogle Scholar
  17. 17.
    Sether LA, Yu S, Haughton VM, Fischer ME (1990) Intervertebral disk: normal age-related changes in MR signal intensity. Radiology 177:385–388PubMedGoogle Scholar
  18. 18.
    Yu S, Haughton VM, Sether LA et al (1989) Criteria for classifying normal and degenerated lumbar intervertebral disks. Radiology 170:523–526PubMedGoogle Scholar
  19. 19.
    Friberg S, Hirsch C (1949) Anatomical and clinical studies on lumbar disc degeneration. Acta Orthop Scand 19:222–242PubMedGoogle Scholar
  20. 20.
    Modic MT, Pavlicek W, Weinstein MA et al (1984) Magnetic resonance imaging of intervertebral disk disease. Clinical and pulse sequence considerations. Radiology 152:103–111PubMedGoogle Scholar
  21. 21.
    Majors AW, McDevitt CA, Silgalis I, Modic MT (1994) A correlative analysis of T2, ADC and MT radio with water, hydroxyproline and GAG content in excised human intervertebral disk. Orthopedic Research Society, New Orleans, pp 116–120Google Scholar
  22. 22.
    Hirsch C (1959) Studies on the pathology of low back pain. J Bone Joint Surg Br 41-B:237–243PubMedGoogle Scholar
  23. 23.
    Coventry MB (1969) Anatomy of the intervertebral disk. Clin Orthop Relat Res 67:9–15BPubMedCrossRefGoogle Scholar
  24. 24.
    Knutsson F (1942) The vacuum phenomenon in the intervertebral discs. Acta Radiol 23:173–179CrossRefGoogle Scholar
  25. 25.
    Bangert BA, Modic MT, Ross JS et al (1995) Hyperintense disks on T1-weighted MR images: correlation with calcification. Radiology 195:437–443PubMedGoogle Scholar
  26. 26.
    de Roos A, Kressel H, Spritzer C, Dalinka M (1987) MR imaging of marrow changes adjacent to end plates in degenerative lumbar disk disease. AJR Am J Roentgenol 149:531–534PubMedGoogle Scholar
  27. 27.
    Masaryk TJ, Boumphrey F, Modic MT et al (1986) Effects of chemonucleolysis demonstrated by MR imaging. J Comput Assist Tomogr 10:917–923PubMedCrossRefGoogle Scholar
  28. 28.
    Modic MT, Steinberg PM, Ross JS et al (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166:193–199PubMedGoogle Scholar
  29. 29.
    Modic MT (2007) Modic type 1 and type 2 changes (editorial). J Neurosurg Spine 6:150–151PubMedCrossRefGoogle Scholar
  30. 30.
    Harris RI, Macnab I (1954) Structural changes in the lumbar intervertebral discs; their relationship to low back pain and sciatica. J Bone Joint Surg Br 36-B:304–322PubMedGoogle Scholar
  31. 31.
    Schellinger D, Wener L, Ragsdale BD, Patronas NJ (1987) Facet joint disorders and their role in the production of back pain and sciatica. Radiographics 7:923–944PubMedGoogle Scholar
  32. 32.
    Arnoldi CC, Brodsky AE, Cauchoix J et al (1976) Lumbar spinal stenosis and nerve root entrapment syndromes. Definition and classification. Clin Orthop Relat Res 115:4–5PubMedGoogle Scholar
  33. 33.
    Amundsen T, Weber H, Lilleas F et al (1995) Lumbar spinal stenosis. Clinical and radiologic features. Spine 20:1178–1186PubMedCrossRefGoogle Scholar
  34. 34.
    ECRI (2001) Treatment of degenerative lumbar spinal stenosis. Volume 1: Evidence report. AHRQ Publication No. 01-E048 32Google Scholar
  35. 35.
    Borenstein DG, O’Mara JW Jr., Boden SD et al (2001) The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects: a seven-year follow-up study. J Bone Joint Surg Am 83-A:1306–1311PubMedGoogle Scholar
  36. 36.
    Mixter W, Barr JS (1934) Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med 211:210–214Google Scholar
  37. 37.
    Freemont AJ, Peacock TE, Goupille P et al (1997) Nerve in-growth into diseased intervertebral disc in chronic back pain. Lancet 350:178–181PubMedCrossRefGoogle Scholar
  38. 38.
    Von Korff M, Saunders K (1996) The course of back pain in primary care. Spine 21:2833–2837CrossRefGoogle Scholar
  39. 39.
    Crock HV (1986) The presidential address: ISSLS, internal disc disruption, a challenge to disc prolapse fifty years on. Spine 11:650–653PubMedCrossRefGoogle Scholar
  40. 40.
    Marshall LL, Trethewie ER, Curtain CC (1977) Chemical radiculitis. A clinical, physiological and immunological study. Clin Orthop Relat Res 129:61–67PubMedGoogle Scholar
  41. 41.
    Lee G (2000) Systemic inflammatory response with plasma C-reactive protein elevation in disk-related lumbosciatic syndrome. Joint Bone Spine 67:452–455Google Scholar
  42. 42.
    Igarashi T, Kikuchi S, Shubayev V, Myers RR (2000) Volvo Award winner in basic science studies: exogenous tumor necrosis factor-alpha mimics nucleus pulposus-induced neuropathology. Molecular, histologic, and behavioral comparisons in rats. Spine 25:2975–2980PubMedCrossRefGoogle Scholar
  43. 43.
    Olmarker K, Rydevik B (2001) Selective inhibition of tumor necrosis factor-alpha prevents nucleus pulposus-induced thrombus formation, intraneural edema, and reduction of nerve conduction velocity: possible implications for future pharmacologic treatment strategies of sciatica. Spine 26:863–869PubMedCrossRefGoogle Scholar
  44. 44.
    Genevay S, Stingelin S, Gabay C (2004) Efficacy of etanercept in the treatment of acute, severe sciatica: a pilot study. Ann Rheum Dis 63:1120–1123PubMedCrossRefGoogle Scholar
  45. 45.
    Karppinen J, Korhonen T, Malmivaara A et al (2003) Tumor necrosis factor-alpha monoclonal antibody, infliximab, used to manage severe sciatica. Spine 28:750–753PubMedCrossRefGoogle Scholar
  46. 46.
    Korhonen T, Karppinen J, Malmivaara A et al (2004) Efficacy of infliximab for disc herniation-induced sciatica: one-year follow-up. Spine 29:2115–2119PubMedCrossRefGoogle Scholar
  47. 47.
    Sox H, Stern S, Owens D, Abrams HL (1989) Assessment of diagnostic technology in health care. Rationale, methods, problems and directions. National Academy Press, Washington DCGoogle Scholar
  48. 48.
    Wiesel SW, Tsourmas N, Feffer HL et al (1984) A study of computer-assisted tomography. I. The incidence of positive CAT scans in an asymptomatic group of patients. Spine 9:549–551PubMedCrossRefGoogle Scholar
  49. 49.
    Boden SD, Davis DO, Dina TS et al (1990) Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 72:403–408PubMedGoogle Scholar
  50. 50.
    Jensen MC, Brant-Zawadzki MN, Obuchowski N et al (1994) Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 331:69–73PubMedCrossRefGoogle Scholar
  51. 51.
    Modic MT, Ross JS, Obuchowski NA et al (1995) Contrast-enhanced MR imaging in acute lumbar radiculopathy: a pilot study of the natural history. Radiology 195:429–435PubMedGoogle Scholar
  52. 52.
    Modic MT, Obuchowski NA, Ross JS et al (2005) Acute low back pain and radiculopathy: MR imaging findings and their prognostic role and effect on outcome. Radiology. 237:597–604PubMedCrossRefGoogle Scholar
  53. 53.
    Vital JM, Gille O, Pointillart V et al (2003) Course of Modic 1 six months after lumbar posterior osteosynthesis. Spine 28:715–720PubMedCrossRefGoogle Scholar
  54. 54.
    Braithwaite I, White J, Saifuddin A et al (1998) Vetebral endplate (Modic) changes on lumbar spine MRI: correlation with pain reproduction at lumbar discography. Eur Spine J 7 363–368PubMedCrossRefGoogle Scholar
  55. 55.
    Buttermann GR, Heithoff KB, Ogilvie JW et al (1997) Vertebral body MRI related to lumbar fusion results. Eur Spine J 6:115–120PubMedCrossRefGoogle Scholar
  56. 56.
    White AA 3rd, Gordon SL (1982) Synopsis: workshop on idiopathic low-back pain. Spine 7:141–149PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Michael T. Modic
    • 1
  • Sean Symons
    • 2
  1. 1.Division of RadiologyLerner College of MedicineClevelandUSA
  2. 2.Department of Medical ImagingSunnybrook Healt Sciences CentreTorontoCanada

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