The evolution of degenerative marrow (Modic) changes in the cervical spine in neck pain patients.

PURPOSE: To evaluate the natural course of end plate marrow (Modic) changes (MC) in the cervical spine on MRI scans of patients with neck pain. A few longitudinal studies have assessed the development of MC over time in the lumbar spine but only two recent studies evaluated MC in the cervical spine in asymptomatic volunteers and those with whiplash. Thus, this study now reports on the natural course of MC in the cervical spine in symptomatic patients. METHODS: From the cervical MRI scans of 426 neck pain patients (mean age 61.2 years), 64 patients had follow-up MRI studies. The prevalence and types of MC were retrospectively assessed on the follow-up scans and compared to the original MRI findings. RESULTS: With an average of 2.5 years between the two MRI scans, the prevalence of MC type 1 (MC1) noted at baseline (7.4% or 19 motion segments) slightly increased (8.2% or 21 segments) but the prevalence of MC2 (14.5% or 37 segments) increased considerably (22.3% or 57 segments). In addition, 14 new MC1 segments and 8 new MC2 segments were noted. Twelve segments with MC1 at baseline converted to MC2 at follow-up. No conversion from MC2 to MC1 or reverting to a normal image was observed. CONCLUSIONS: MC in the cervical spine are a dynamic phenomenon similar to the lumbar spine.

Degenerative marrow (modic) changes on cervical spine magnetic resonance imaging scans: prevalence, inter- and intra-examiner reliability and link to disc herniation.

STUDY DESIGN: A prevalence and reliability study of Modic changes (MCs) in the cervical spine. OBJECTIVE: To assess the prevalence and reliability of diagnosing and classifying MCs and their relationship to disc herniations (DHs) in the cervical spine. SUMMARY OF BACKGROUND DATA: Degenerative marrow (Modic) changes in the spine can be seen on MRI with some evidence linking them to pain. Many studies have been published on MCs in the lumbar spine, but only one small prevalence study focusing on MCs in the cervical spine has been reported. METHODS: The cervical magnetic resonance imaging (MRI) scans of 500 patients over the age of 50 were retrospectively evaluated for the prevalence, type, and location of MCs and DHs. Two hundred of these same scans were independently analyzed by a second observer to evaluate interobserver reliability of diagnosis with 100 re-evaluated by the same observer 1 month later to assess intraobserver reliability. The SPSS program and Kappa statistics were used to assess prevalence and reliability. The risk ratio comparison of DH and MC was calculated. RESULTS: Four hundred and twenty-six patients (85.2%) met the inclusion criteria. MCs were observed in 40.4% of patients (14.4% of all motion segments). A 4.3% were type 1 and 10.1% were type 2. DH were seen in 78.2% of patients (13.3% of motion segments). Both MC and DH were most frequently observed at C5/6 and C6/7. Disc extrusions were positively associated with MC (RR=2.4). The reliability showed an upper moderate interobserver (k=0.54) and an almost perfect intraobserver agreement (k=0.82). CONCLUSION: A high prevalence of MCs was observed with type 2 predominating. The C5/6 and C6/7 levels are most effected. Patients with MC are more likely to have a DH at the same level. MC type 2 predominates. The classification is reliable.

Does airborne nickel exposure induce nickel sensitization?

BACKGROUND AND OBJECTIVE: Nickel is one of the most prevalent causes of contact allergy in the general population. This study focuses on human exposure to airborne nickel and its potential to induce allergic sensitization. MATERIALS AND METHODS: The study group consisted of 309 children at school-starter age living in the West of Germany in the vicinity of two industrial sources and in a rural town without nearby point sources of nickel. An exposure assessment of nickel in ambient air was available for children in the Ruhr district using routinely monitored ambient air quality data and dispersion modelling. Internal nickel exposure was assessed by nickel concentrations in morning urine samples of the children. RESULTS: The observed nickel sensitization prevalence rates varied between 12.6% and 30.7%. Statistically significant associations were showed between exposure to nickel in ambient air and urinary nickel concentration as well as between urinary nickel concentration and nickel sensitization. Furthermore, an elevated prevalence of nickel sensitization was associated with exposure to increased nickel concentrations in ambient air. CONCLUSION: The observed associations support the assumption that inhaled nickel in ambient air might be a risk factor for nickel sensitization; further studies in larger collectives are necessary.