Lumbar alterations in magnetic resonance: correlation
               between Modic and Pfirrmann classifications

Rodrigues, Luciano Miller Reis; Yoshino, Caio Vargas; Costa, Alexandre Barros

doi:10.1590/S1808-18512014130300263

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Original Articles • Coluna/Columna 13 (3) • Jul-Sep 2014 • https://doi.org/10.1590/S1808-18512014130300263 copy

Lumbar alterations in magnetic resonance: correlation between Modic and Pfirrmann classifications

Alterações lombares na ressonância magnética: correlação entre as classificações de Modic e Pfirrmann

Alteraciones lumbares en la resonancia magnética: correlación entre las clasificaciones de Modic y Pfirrmann

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

To evaluate the relationship of sex and age with Modic and Pfirrmann classifications and verify the relationship between the two classifications in the group of patients studied.

METHODS:

300 magnetic resonance scans (MRI) of the lumbar segment of the patients were evaluated; each lumbar segment (L1-L2, L2-L3, L3-L4, L4-L5 and L5-S1) was assessed according to Modic and Pfirrmann classifications.

RESULTS:

The type III of Pfirrmann was the most prevalent, whereas Modic was absent on most levels analyzed. The Modic signal was present mainly in the lower levels (L4-L5 and L5-S1) and in females.

CONCLUSION:

There is a strong correlation between the changes of the endplate and intervertebral discs, evidenced by changes in MRI. The relationship between Pfirrmann and Modic classifications is statistically higher the greater the disc degeneration.

Spine; Intervertebral disc; Magnetic resonance imaging

Variable	N	%
Sex
Female	178	59.3
Male	122	40.7
Age group
< 40 years	56	18.7
40 to 60 years	160	53.3
> 60 years	84	28.0
Total	300	100

Pfirrmann	L12		L23		L34		L45		L5S1		All discs
Pfirrmann	N	%	N	%	N	%	N	%	N	%	N	%
Type I	0	0.0	0	0.0	0	0.0	5	1.7	0	0.0	5	0.3
Type II	124	41.3	83	27.7	53	17.7	36	12.0	35	11.7	331	22.1
Type III	90	30.0	112	37.3	122	40.7	88	29.3	102	34.0	514	34.3
Type IV	58	19.3	73	24.3	87	29.0	99	33.0	93	31.0	410	27.3
Type V	28	9.3	32	10.7	38	12.7	72	24.0	70	23.3	240	16.0
Total	300	100	300	100	300	100	300	100	300	100	1500	100

Modic	L12		L23		L34		L45		L5S1		All discs
Modic	N	%	N	%	N	%	N	%	N	%	N	%
Absent	282	94.0	285	95.0	266	88.7	247	82.3	250	83.3	1330	88.7
Type 1	5	1.7	1	0.3	3	1.0	10	3.3	2	0.7	21	1.4
Type 2	13	4.3	14	4.7	31	10.3	43	14.3	48	16.0	149	9.9
Total	300	100	300	100	300	100	300	100	300	100	1500	100

Sex
Variable	Female		Male		Total		p
	N	%	N	%	N	%
Pfirrmann L12							0.298
Type II	71	39.9	53	43.4	124	41.3
Type III	53	29.8	37	30.3	90	30.0
Type IV	32	18.0	26	21.3	58	19.3
Type V	22	12.4	6	4.9	28	9.3
Pfirrmann L23							0.008
Type II	43	24.2	40	32.8	83	27.7
Type III	62	34.8	50	41.0	112	37.3
Type IV	49	27.5	24	19.7	73	24.3
Type V	24	13.5	8	6.6	32	10.7
Pfirrmann L34							0.008
Type II	31	17.4	22	18.0	53	17.7
Type III	60	33.7	62	50.8	122	40.7
Type IV	57	32.0	30	24.6	87	29.0
Type V	30	16.9	8	6.6	38	12.7
Pfirrmann L45							0.251
Type I	5	2.8	0	0.0	5	1.7
Type II	16	9.0	20	16.4	36	12.0
Type III	58	32.6	30	24.6	88	29.3
Type IV	46	25.8	53	43.4	99	33.0
Type V	53	29.8	19	15.6	72	24.0
Pfirrmann L5S1							0.817
Type II	17	9.6	18	14.8	35	11.7
Type III	69	38.8	33	27.0	102	34.0
Type IV	50	28.1	43	35.2	93	31.0
Type V	42	23.6	28	23.0	70	23.3
Total	178	100	122	100	300	100
Results of the Mann-Whitney test

Sex
Variable	Female		Male		Total		p
	N	%	N	%	N	%
Modic L12							0.873
Absent	167	93.8	115	94.3	282	94.0
Type 1	3	1.7	2	1.6	5	1.7
Type 2	8	4.5	5	4.1	13	4.3
Modic L23							0.261
Absent	167	93.8	118	96.7	285	95.0
Type 1	1	0.6	0	0.0	1	0.3
Type 2	10	5.6	4	3.3	14	4.7
Modic L34							0.001
Absent	149	83.7	117	95.9	266	88.7
Type 1	3	1.7	0	0.0	3	1.0
Type 2	26	14.6	5	4.1	31	10.3
Modic L45							0.420
Absent	144	80.9	103	84.4	247	82.3
Type 1	6	3.4	4	3.3	10	3.3
Type 2	28	15.7	15	12.3	43	14.3
Modic L5S1							0.100
Absent	143	80.3	107	87.7	250	83.3
Type 1	2	1.1	0	0.0	2	0.7
Type 2	33	18.5	15	12.3	48	16.0
Total	178	100	122	100	300	100

Variable	< 40 years		40 to 60 years		> 60 years		Total		p
	Age group
	N	%	N	%	N	%	N	%
Pfirrmann L12									<0.001
Type II	38	67.9	70	43.8	16	19.0	124	41.3
Type III	12	21.4	49	30.6	29	34.5	90	30.0
Type IV	6	10.7	29	18.1	23	27.4	58	19.3
Type V	0	0.0	12	7.5	16	19.0	28	9.3
Pfirrmann L23									<0.001
Type II	35	62.5	42	26.3	6	7.1	83	27.7
Type III	17	30.4	63	39.4	32	38.1	112	37.3
Type IV	2	3.6	41	25.6	30	35.7	73	24.3
Type V	2	3.6	14	8.8	16	19.0	32	10.7
Pfirrmann L34									<0.001
Type II	27	48.2	24	15.0	2	2.4	53	17.7
Type III	23	41.1	66	41.3	33	39.3	122	40.7
Type IV	4	7.1	46	28.8	37	44.0	87	29.0
Type V	2	3.6	24	15.0	12	14.3	38	12.7
Pfirrmann L45									<0.001
Type I	3	5.4	0	0.0	2	2.4	5	1.7
Type II	18	32.1	16	10.0	2	2.4	36	12.0
Type III	22	39.3	42	26.3	24	28.6	88	29.3
Type IV	11	19.6	62	38.8	26	31.0	99	33.0
Type V	2	3.6	40	25.0	30	35.7	72	24.0
Pfirrmann L5S1									0.127
Type II	11	19.6	20	12.5	4	4.8	35	11.7
Type III	16	28.6	52	32.5	34	40.5	102	34.0
Type IV	21	37.5	54	33.8	18	21.4	93	31.0
Type V	8	14.3	34	21.3	28	33.3	70	23.3
Total	56	100	160	100	84	100	300	100
Results of the Kruskal-Wallis test

Variable	< 40 years		40 to 60 years		> 60 years		Total		p
	Age group
	N	%	N	%	N	%	N	%
Modic L12									0.066
Absent	56	100.0	150	93.8	76	90.5	282	94.0
Type 1	0	0.0	3	1.9	2	2.4	5	1.7
Type 2	0	0.0	7	4.4	6	7.1	13	4.3
Modic L23									0.143
Absent	56	100.0	151	94.4	78	92.9	285	95.0
Type 1	0	0.0	1	0.6	0	0.0	1	0.3
Type 2	0	0.0	8	5.0	6	7.1	14	4.7
Modic L34									0.012
Absent	56	100.0	138	86.3	72	85.7	266	88.7
Type 1	0	0.0	3	1.9	0	0.0	3	1.0
Type 2	0	0.0	19	11.9	12	14.3	31	10.3
Modic L45									0.144
Absent	51	91.1	128	80.0	68	81.0	247	82.3
Type 1	2	3.6	6	3.8	2	2.4	10	3.3
Type 2	3	5.4	26	16.3	14	16.7	43	14.3
Modic L5S1									0.009
Absent	52	92.9	136	85.0	62	73.8	250	83.3
Type 1	0	0.0	1	0.6	1	1.2	2	0.7
Type 2	4	7.1	23	14.4	21	25.0	48	16.0
Total	56	100	160	100	84	100	300	100
Results of the Kruskal-Wallis test

Disc	Pfirrmann	Absent		Type 1		Type 2		Total		p
		Modic
		N	%	N	%	N	%	N	%
L12	Type II	120	42.6	0	0.0	4	30.8	124	41.3	<0.001
	Type III	88	31.2	2	40.0	0	0.0	90	30.0
	Type IV	56	19.9	0	0.0	2	15.4	58	19.3
	Type V	18	6.4	3	60.0	7	53.8	28	9.3
	Total	282	100	5	100	13	100	300	100
L23	Type II	82	28.8	0	0.0	1	7.1	83	27.7	0.003
	Type III	108	37.9	0	0.0	4	28.6	112	37.3
	Type IV	68	23.9	0	0.0	5	35.7	73	24.3
	Type V	27	9.5	1	100.0	4	28.6	32	10.7
	Total	285	100	1	100	14	100	300	100
L34	Type II	53	19.9	0	0.0	0	0.0	53	17.7	<0.001
	Type III	115	43.2	0	0.0	7	22.6	122	40.7
	Type IV	72	27.1	0	0.0	15	48.4	87	29.0
	Type V	26	9.8	3	100.0	9	29.0	38	12.7
	Total	266	100	3	100	31	100	300	100
L45	Type I	5	2.0	0	0.0	0	0.0	5	1.7	<0.001
	Type II	36	14.6	0	0.0	0	0.0	36	12.0
	Type III	78	31.6	4	40.0	6	14.0	88	29.3
	Type IV	85	34.4	0	0.0	14	32.6	99	33.0
	Type V	43	17.4	6	60.0	23	53.5	72	24.0
	Total	247	100	10	100	43	100	300	100
L5S1	Type II	33	13.2	0	0.0	2	4.2	35	11.7	<0.001
	Type III	94	37.6	0	0.0	8	16.7	102	34.0
	Type IV	89	35.6	0	0.0	4	8.3	93	31.0
	Type V	34	13.6	2	100.0	34	70.8	70	23.3
	Total	250	100	2	100	48	100	300	100
Results of Spearman’s correlation

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