Skip to main content
Log in

Vertebral endplate change as a feature of intervertebral disc degeneration: a heritability study

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To study the prevalence of vertebral endplate or Modic change (MC), the progression of MC over a 10-year follow-up and the heritability of MC prevalence in a classical twin study.

Methods

The study population was recruited from TwinsUK register between 1996 and 2000. MC was evaluated from T2-weighted lumbar magnetic resonance imaging (MRI) at baseline and follow-up. Heritability was estimated using variance components analysis. Baseline MRI with appropriate data was available for 831 twins and follow-up for 436 twins. In total, both baseline and follow-up imaging were available for 347 twins.

Results

Mean age of the study population was 54.1 years (range 45.7–62.5) and females comprised 96 %. The prevalence of MC at baseline was 32.1 % and at follow-up 48.4 %. The incidence of MC during the 10-year follow-up was 21.6 % and was highest at L4–5 and L5–S1. MC regressed totally in 3.5 % of twins. Twins with prevalent MC at baseline demonstrated a higher incidence of MC at upper lumbar levels during follow-up compared to twins without baseline MC (p = 0.009). Probandwise concordance rates were higher in monozygotic (0.56) than dizygotic twin pairs (0.39) suggestive of familial influence. Heritability of MC prevalence was estimated at 30 (16–43) %.

Conclusions

The results suggest that MC is generally progressive in middle age and furthermore is heritable. Since MC is associated with disc degeneration, which is also heritable, further work on potential shared mechanisms is needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Reference

  1. Murray CJ, Vos T, Lozano R et al (2013) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2197–2223

    Article  Google Scholar 

  2. Livshits G, Popham M, Malkin I, Sambrook PN, Macgregor AJ, Spector T, Williams FM (2011) Lumbar disc degeneration and genetic factors are the main risk factors for low back pain in women: the UK Twin Spine Study. Ann Rheum Dis 70:1740–1745

    Article  PubMed Central  PubMed  Google Scholar 

  3. MacGregor AJ, Andrew T, Sambrook PN, Spector TD (2004) Structural, psychological, and genetic influences on low back and neck pain: a study of adult female twins. Arthritis Rheum 51:160–167

    Article  PubMed  Google Scholar 

  4. Williams FM, Popham M, Sambrook PN, Jones AF, Spector TD, MacGregor AJ (2011) Progression of lumbar disc degeneration over a decade: a heritability study. Ann Rheum Dis 70:1203–1207

    Article  PubMed Central  PubMed  Google Scholar 

  5. Modic MT, Masaryk TJ, Ross JS, Carter JR (1988) Imaging of degenerative disk disease. Radiology 168(1):177–186

    Article  CAS  PubMed  Google Scholar 

  6. Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166:193–199

    Article  CAS  PubMed  Google Scholar 

  7. Jensen TS, Karppinen J, Sorensen JS, Niinimaki J, Leboeuf-Yde C (2008) Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J 17:1407–1422

    Article  PubMed Central  PubMed  Google Scholar 

  8. Kuisma M, Karppinen J, Niinimaki J et al (2007) Modic changes in endplates of lumbar vertebral bodies: prevalence and association with low back and sciatic pain among middle-aged male workers. Spine (Phila Pa 1976) 32:1116–1122

    Article  Google Scholar 

  9. Lim CH, Jee WH, Son BC, Kim DH, Ha KY, Park CK (2005) Discogenic lumbar pain: association with MR imaging and CT discography. Eur J Radiol 54:431–437

    Article  PubMed  Google Scholar 

  10. Battie MC, Videman T, LE Gibbons, Fisher LD, Manninen H, Gill K (1995) 1995 Volvo Award in clinical sciences. Determinants of lumbar disc degeneration. A study relating lifetime exposures and magnetic resonance imaging findings in identical twins. Spine (Phila Pa 1976) 20:2601–2612

    Article  CAS  Google Scholar 

  11. Sambrook PN, MacGregor AJ, Spector TD (1999) Genetic influences on cervical and lumbar disc degeneration: a magnetic resonance imaging study in twins. Arthritis Rheum 42:366–372

    Article  CAS  PubMed  Google Scholar 

  12. Moayyeri A, Hammond CJ, Hart DJ, Spector TD (2013) The UK adult twin registry (twins UK resource). Twin Res Hum Genet 16:144–149

    Article  PubMed Central  PubMed  Google Scholar 

  13. Neale MC, Boker SM, Xie G, Maes HH (2006) Mx: statistical modeling, 7th edn. VCU, Department of Psychiatry, Richmond

    Google Scholar 

  14. Rijsdijk FV, Sham PC (2002) Analytic approaches to twin data using structural equation models. Brief Bioinform 3:119–133

    Article  CAS  PubMed  Google Scholar 

  15. Albert HB, Manniche C (2007) Modic changes following lumbar disc herniation. Eur Spine J 16:977–982

    Article  PubMed Central  PubMed  Google Scholar 

  16. Kerttula L, Luoma K, Vehmas T, Gronblad M, Kaapa E (2012) Modic type I change may predict rapid progressive, deforming disc degeneration: a prospective 1-year follow-up study. Eur Spine J 21:1135–1142

    Article  PubMed Central  PubMed  Google Scholar 

  17. Kjaer P, Leboeuf-Yde C, Korsholm L, Sorensen JS, Bendix T (2005) Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year-old men and women. Spine (Phila Pa 1976) 30:1173–1180

    Article  Google Scholar 

  18. Ryder JJ, Garrison K, Song F et al (2008) Genetic associations in peripheral joint osteoarthritis and spinal degenerative disease: a systematic review. Ann Rheum Dis 67:584–591

    Article  CAS  PubMed  Google Scholar 

  19. Urban JP, Roberts S (2003) Degeneration of the intervertebral disc. Arthritis Res Ther 5:120–130

    Article  PubMed Central  PubMed  Google Scholar 

  20. Mefford J, Sairyo K, Sakai T et al (2011) Modic type I changes of the lumbar spine in golfers. Skeletal Radiol 40:467–473

    Article  PubMed Central  PubMed  Google Scholar 

  21. Jensen TS, Bendix T, Sorensen JS, Manniche C, Korsholm L, Kjaer P (2009) Characteristics and natural course of vertebral endplate signal (Modic) changes in the Danish general population. BMC Musculoskelet Disord 10:81

    Article  PubMed Central  PubMed  Google Scholar 

  22. Wang Y, Videman T, Battié MC (2012) Modic changes: prevalence, distribution patterns, and association with age in white men. Spine J 12:411–416

    Article  CAS  PubMed  Google Scholar 

  23. Kuisma M, Karppinen J, Niinimaki J, Kurunlahti M, Haapea M, Vanharanta H, Tervonen O (2006) A three-year follow-up of lumbar spine endplate (Modic) changes. Spine (Phila Pa 1976) 31:1714–1718

    Article  Google Scholar 

  24. Adams MA, Dolan P (2012) Intervertebral disc degeneration: evidence for two distinct phenotypes. J Anat 221:497–506

    Article  PubMed  Google Scholar 

  25. Battie MC, Videman T, Levalahti E, Gill K, Kaprio J (2008) Genetic and environmental effects on disc degeneration by phenotype and spinal level: a multivariate twin study. Spine (Phila Pa 1976) 33:2801–2808

    Article  Google Scholar 

  26. Andrew T, Hart DJ, Snieder H, de Lange M, Spector TD, MacGregor AJ (2001) Are twins and singletons comparable? A study of disease-related and lifestyle characteristics in adult women. Twin Res 4:464–477

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank the twins who volunteered to take part in the study. The study was funded by the Wellcome Trust; European Community’s Seventh Framework Programme (FP7/2007-2013). The study also received support from the National Institute for Health Research (NIHR) Clinical Research Facility and Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, and the Finnish Academy (Jaro Karppinen, project number 121620). The authors would like to thank Dr Michael T. Modic, MD for his invaluable comments on the interpretation of the MR scans.

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Juhani H. Määttä.

Additional information

J. Määttä, M. Kraatari contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Määttä, J.H., Kraatari, M., Wolber, L. et al. Vertebral endplate change as a feature of intervertebral disc degeneration: a heritability study. Eur Spine J 23, 1856–1862 (2014). https://doi.org/10.1007/s00586-014-3333-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-014-3333-8

Keywords

Navigation