Clinical Impact of Disc Degeneration, Modic Changes, and Paraspinal Muscle Atrophy: A Cross-Sectional Observational Study

Abstract

Objective: This study set out to explore how lumbar disc degeneration, Modic changes, and atrophy of the paraspinal muscles—detected using MRI—are connected to pain intensity and functional disability in individuals with low back pain (LBP). Materials and Methods: Fifty-two adults (18 years or older) who had been experiencing LBP for at least three months and had MRI scans of the lumbar spine were included. Pain and disability levels were measured using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). MRI scans were analyzed for structural changes: disc degeneration was assessed with the Pfirrmann grading system, Modic changes were classified into types 1 through 3, and multifidus muscle atrophy was graded from 0 (normal) to 4 (severe). Statistical analysis included correlation and group comparisons. Results: Disc degeneration was most frequently observed at the L4–L5 segment (77%), while paraspinal muscle atrophy was most common at the L5–S1 level (39%). Degeneration at the L3–L4 level was strongly associated with both VAS and ODI scores (p<0.01). Atrophy of the multifidus muscle at L5–S1 had the strongest link with ODI scores (ρ=0.586; p<0.001). Modic type 2 changes were common at both L4–L5 and L5–S1 and were significantly related to higher VAS scores. No significant differences were found between men and women. However, patients aged 50 and older had notably higher pain and disability scores, as well as more pronounced degenerative changes on MRI (p<0.05). Conclusion: Lumbar disc degeneration, Modic changes, and atrophy of the paraspinal muscles are key structural markers associated with increased pain and functional impairment in patients with LBP. MRI analysis by specific spinal segments may improve diagnostic accuracy and help guide more personalized treatment strategies.

Keywords

• Low back pain
• Disc degeneration
• Modic changes
• Muscle atrophy
• MRI
• VAS
• ODI

Disk Dejenerasyonu, Modic Değişiklikleri ve Kas Atrofisinin Klinik Yansımaları: Gözlemsel Bir Çalışma

Abstract

Amaç: Bu çalışma, lomber disk dejenerasyonu, Modic değişiklikleri ve paraspinal kasların atrofi durumunun—MRI kullanılarak tespit edilen—bel ağrısı şiddeti ve fonksiyonel yetersizlik ile ilişkisini araştırmayı amaçladı. Gereç ve Yöntem: En az üç aydır bel ağrısı yaşayan ve lomber omurga MRI görüntülemesi bulunan 52 yetişkin çalışmaya dahil edildi. Ağrı ve yetersizlik düzeyleri Vizüel Analog Skala (VAS) ve Oswestry Engellilik Endeksi (OEE) ile değerlendirildi. MRI taramaları yapısal değişiklikler açısından incelendi: disk dejenerasyonu Pfirrmann derecelendirme sistemi ile, Modic değişiklikleri tip 1’den tip 3’e kadar sınıflandırıldı, multifidus kas atrofisi ise 0 (normal) ile 4 (şiddetli) arasında derecelendirildi. İstatistiksel analizde korelasyon ve grup karşılaştırmaları yapıldı. Bulgular: Disk dejenerasyonu en sık L4–L5 segmentinde (%77) gözlendi, paraspinal kas atrofisi ise en yaygın L5–S1 seviyesinde (%39) bulundu. L3–L4 düzeyindeki dejenerasyon hem VAS hem de OEE skorları ile güçlü bir ilişki gösterdi (p<0.01). L5–S1’deki multifidus kas atrofisi, OEE skorlarıyla en güçlü ilişkiyi ortaya koydu (ρ=0.586; p<0.001). Modic tip 2 değişiklikleri hem L4–L5 hem de L5–S1’de yaygındı ve daha yüksek VAS skorlarıyla anlamlı şekilde ilişkiliydi. Elli yaş ve üzerindeki hastalarda ağrı ve yetersizlik skorları belirgin derecede daha yüksek, MRI’da ise dejeneratif değişiklikler daha belirgin bulundu (p<0.05). Sonuç: Lomber disk dejenerasyonu, Modic değişiklikleri ve paraspinal kas atrofisi; bel ağrısı olan hastalarda artmış ağrı ve fonksiyonel bozukluk ile ilişkili önemli yapısal belirteçlerdir. Omurga segmentlerine özel MRI analizi, tanısal doğruluğu artırabilir ve daha kişiselleştirilmiş tedavi stratejilerinin yönlendirilmesine yardımcı olabilir.

Keywords

• Bel ağrısı
• Disk dejenerasyonu
• Modic değişiklikleri
• Kas atrofisi
• MRI
• VAS
• OEE.

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