The Role of Intervertebral Disc Cartilage Fragments in Modic Changes

Inflammation of the vertebral endplate and bone marrow are often seen in patients with chronic low back pain on MRIs. These changes are known as Modic type 1 changes (MC1). They occur adjacent to a degenerated intervertebral disc. In most cases disc degeneration does not cause pain. In contrast, MC1 are a source of pain in most cases. 

The aim of this study is to identify molecules that are overrepresented in MC1 and cause inflammation, and to find ways of inhibiting this process. From low back pain patients with MC1 who underwent lumbar spinal fusion at the Balgrist University Hospital we collected and analyzed the intervertebral disc tissue that was excised during this procedure. We found that molecular fragments of intervertebral disc cartilage proteins are much more abundant in MC1 tissue. We demonstrated that some of these fragments can cause infl ammation and degenerative changes in the intervertebral disc cartilage, which is typical for MC1. We also identifi ed the molecular mechanisms that generate these protein fragments and cause inflammation. Importantly, we successfully showed that blocking these mechanisms prevents infl ammation and degenerative changes.