Endplate Modic Changes of L5

Clinical Significance and Management

• The American College of Neurosurgery suggests that Modic changes at L5-S1 show significant association with pain symptoms, particularly Type 1 lesions and extensive lesions 1
• The Journal of Neurosurgery guidelines indicate that MRI is very sensitive at detecting disc changes but not specific for identifying pain sources 2
• The North American Spine Society recommends reserving surgical intervention for cases with documented instability, spondylolisthesis, or when extensive decompression might create instability, not based solely on Modic changes 3
• For patients with chronic low back pain and Modic changes at L5, epidural steroid injections may provide short-term relief (less than 2 weeks), but have limited evidence for chronic low back pain without radiculopathy 3