Predictive Role of MRI-Detected Modic Changes in the Chronicity and Severity of Low Back Pain: A Systematic Review and Meta-Analysis

The main focus of this systematic review and meta-analysis was to establish a correlation between vertebral subchondral endplate changes (Modic changes, or MCs) and low back pain (LBP). This review also wanted to determine whether MCs serve as valid predictors of progressive degenerative spinal diseases and surgical outcomes. In accordance with PRISMA guidelines, an extensive literature search was conducted across major databases for peer-reviewed studies published up to 31 May 2025. The Joanna Briggs Institute (JBI) instrument and the Newcastle-Ottawa Scale (NOS) were used in assessing the quality of the studies. Data from 18 studies that involved about 4,637 patients were used in this review. The demographic risk factors, anatomical distribution, and clinical correlations were obtained from the included studies. In compliance with our primary objective, the meta-analysis revealed that increasing age is a notable risk factor, exhibiting a mean difference of 2.43 years (95% CI: 1.09 to 3.76) between the MC and non-MC groups. The majority of the males presented with MCs (OR: 1.51), although BMI did not exhibit a statistically significant link (p = 0.705). According to the secondary objective, MCs were common in the L4-L5 and L5-S1 intervertebral discs (IVDs). A significant correlation was identified between MCs and spondylolisthesis (OR: 50.50) as well as disc herniation. In terms of surgical outcomes, Modic type 3 changes (sclerotic) were linked to significantly lower fusion rates (54.5%) in posterior lumbar interbody fusion (PLIF) than in other types. It was known that smoking was a major risk factor for poor surgical recovery in people with type 1 MCs. MCs provide a "visible map" of the history of spinal degeneration, closely associated with mechanical instability and previous IV-disc herniations. Although MCs are a standalone indicator of chronic LBP, their subtypes have a considerable impact on the surgical outcomes. Preoperative MRI phenotyping, specifically distinguishing between inflammatory type 1 and sclerotic type 3, is essential for managing patient expectations and deciding on suitable surgical interventions to reduce risks such as cage subsidence or non-union.