Congjie Li1*, Wenshan Gao2*, Xiaowei Yao3, Tong Tong1, Yunsheng Wang1, Wenshuai Li1, Junchuan Liu1, Xiaozhe Zhou2, Jilong An2, Bo Yu2, Linfeng Wang1

1Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
2Department of Orthopaedic Surgery, Affiliated Hospital of Hebei University, Hebei Province, People’s Republic of China
3Department of Orthopedics, Hebei Chest Hospital, Shijiazhuang, People’s Republic of China

Keywords: Dyslipidemia, endplate bone quality, fat distribution, intervertebral disk degeneration, Modic change, vertebral bone quality.


Objectives: This study aimed to investigate differences in vertebral fat distribution and bone density between patients with and without Modic changes (MCs) using a magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) scoring system.

Patients and methods: In this retrospective study, 189 patients (95 males, 94 females; mean age: 54±2.2 years; range, 18 to 82 years) with primary single-level disk herniation were reviewed between June 2021 and June 2022. The patients were divided into the MC group (n=99) and the non-MC (NMC) group (n=90). The subcutaneous fat tissue thickness and bone mineral density were determined. The system consisted of two scores: the VBQ score, which reflected the fatty infiltration within the vertebral body, and the endplate bone quality (EBQ) score, which reflected the signal intensity (SI) of the upper and lower endplates. The EBQ score is a novel measurement that we introduced in this study. The VBQ and EBQ were measured and scored using MRI scans. The mean SI of the upper and lower endplates (endplate SI)/the bone marrow SI (marrow SI) was measured.

Results: There was a considerable difference in subcutaneous fat tissue thickness between the MC and NMC groups (1.40 vs. 1.16 cm, p=0.01). The EBQ scores of the L4 and L5 vertebrae and endplate SI/marrow SI of all vertebral body levels were significantly higher in the MC group.

Conclusion: The occurrence of MCs in the lumbar spine may be associated with abnormal fat distribution. The distribution of vertebral fat in patients with MCs is distributed earlier in the upper and lower endplates of the vertebral body, and this trend is not observed in patients without MC. The thickness of subcutaneous fat tissue is a key factor in the occurrence of MCs.

* The two authors contributed equally to this study.

Citation: Li C, Gao W, Yao X, Tong T, Wang Y, Li W, et al. The magnetic resonance imaging-based vertebral bone quality scoring system: A novel method to evaluate endplate changes in patients with primary single-level disk herniation and Modic changes. Jt Dis Relat Surg 2024;35(2):257-266. doi: 10.52312/ jdrs.2024.1527.

Ethics Committee Approval

The study protocol was approved by the Third Hospital of Hebei Medical University Ethics Committee (date: 25.10.2022, no: Ke 2022-115-1). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Conception and design: C.J.L., W.S.G.; Administrative support: X.W.Y., T.T.; Provision of study materials or patients: Y.S.W., J.L.A.; Collection and assembly of data: L.F.W., C.J.L., W.S.G.; Data analysis and interpretation: X.W.Y., J.L.A.; Manuscript writing and final approval of manuscript: All authors.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.