What are Modic Changes and what do they have to do with my herniated Disc - Neufeld Kleinberg & Pinkiert, PA
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What are
Modic Changes and what do they have to do with my herniated Disc

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When a client of mine gets an MRI scan, they will often come back with intervertebral disc herniations or disc bulges. The problem is that more information is needed to determine if the herniation: (a) arose before or after the injury event; and (b) if it is causing my client’s pain. People are more likely to naturally develop herniations as they age. In fact: 4-28 percent of adults will naturally have a lumbar herniation with no pain; and 4-8 percent of asymptomatic adults will naturally have a cervical herniation with no pain (according to a 1990 study in the Journal of Bone and Joint Surgery and a 2005 study published in the Journal of Whiplash and Related Disorders, respectively).

These degenerative or preexisting herniations are more likely to be found among the elderly. So it is much easier to correlate a herniation to a specific injury / car accident in my younger clients.

For additional help, we will look at the hydration levels of the immediately surrounding discs (desiccation or low levels of hydration indicate a chronic degenerative process).

In addition, we will look at the changes to the vertebral bodies immediately adjacent to the bulging or herniated disc at issue. These changes to the vertebral bodies are referred to as Modic Changes (first studied by Dr. Michael Modic in 1988) and can only been seen via MRI imaging.

There are three different types of Modic Changes:

Type I Modic Changes

Describes a bone-marrow edema (Seen when there is a decreased signal on T1 and a corresponding increase in signal on T2).

  • T1 and T2 refer to how different materials are magnetized by the MRI machine (e.g. on a T1 scan, hydrated tissues appear dark, fat looks brighter; on T2-weighted scan, hydrated tissues appear bright, fat appears darker). Type 1 modic changes are best seen on a T2-weighted MRI.
  • Edema just means fluid buildup – but it can cause painful
    swelling and can be associated with an acute injury. Marrow edema may also be indicative of a cancerous tumor or osteoporosis. In an auto-injury context, Type I Modic Changes may be a byproduct of a bone bruise or ligament injury.

As an aventura personal-injury attorney, my job is to try to prove that your pain and suffering was in fact caused your recent accident. To that end, I want to see Type I Modic changes right next to a herniated disc.

Type II Modic Changes

Type I Modic changes may eventually turn into a type II modic change. Seen with an increase signal on T1 or slightly hyperintense signal on T2. Type II modic changes are associated with chronic endplate changes – a degenerative condition and will be difficult for a personal injury attorney to associate with an injury. I.e. people naturally develop type II modic changes as they age.

Type III (decrease T1 and T2 signal) also associated with chronic / degenerative changes likely unrelated to a recent injury.

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By: Jason Neufeld