Modic changes on MRI are signal changes in the bone of the vertebra right next to a disc. They are graded Type 1, 2 or 3.
What are the different types of Modic changes?
- Type 1 means inflammation and edema (fluid) in the bone marrow. It is the type most consistently associated with pain.
- Type 2 means the marrow has turned to fat. It is usually more stable.
- Type 3 means sclerosis: hardened bone.
- Types can change into one another over time, and Type 1 in particular can settle.
What does a Type 1 Modic change on an MRI mean?
Type 1 changes at a level that matches your pain are one of the more telling findings on a spine MRI. They point to the vertebral endplate as a pain source, not the disc itself. See vertebrogenic pain.
Remember the general rule. Findings like this one are common in people with no pain at all. They get steadily more common with age. A finding on a report is not a diagnosis until someone has matched it to your symptoms and your exam. See understanding your MRI report.
Bring your scan and report in and we will go through it with you. Call us or request an appointment.
Related: another endplate finding on the same scan is a Schmorl’s node.
What are Modic changes on an MRI?
Modic changes are signal changes in the bone right next to a disc, graded Type 1 through 3. Type 1 means marrow edema (fluid) and inflammation. It is the type most consistently linked with pain. Type 2 means the marrow has turned to fat, and it is usually more stable. Type 3 means sclerosis (hardened bone). Types change into one another over time, and Type 1 in particular can settle. When Type 1 changes sit at a level that matches the exam, they point to the vertebral endplate as a pain source, not the disc itself. That is a specific finding we can treat.
Frequently asked questions
Are Modic changes an infection?
Type 1 can look like early infection on imaging. That is why we take the difference seriously when there is fever or a history that fits. In the usual case it is degenerative (the bone and disc breaking down).
Do they go away?
Types can change over time, and Type 1 changes in particular may settle. They are not always permanent.
Does the type matter for treatment?
Yes. Type 1 changes at a level that matches your exam point to the endplate as a source. That opens specific treatment options that Type 2 or 3 changes do not carry in the same way.
The endplate treatment is explained in Intracept — Basivertebral Nerve Ablation.
Are Modic changes serious?
It depends on the type and on whether it matches your pain. Findings like this are common in people with no pain at all and get more common with age. Type 2 is usually stable. Type 1, the inflamed type, is the one most consistently linked with back pain. When it sits at the level that matches your exam, it is a specific finding we can treat, not something to fear.
How are Modic changes diagnosed?
Modic changes are seen on an MRI as signal changes in the bone right next to a disc. The report grades them Type 1, 2 or 3. The scan alone is not the diagnosis. The finding counts only once someone has matched the level and the type to your symptoms and your exam. That is what we do when you bring your scan and report in.
What is the best treatment for Modic changes?
Treatment follows the type and how well it matches your exam. Type 1 changes at a level that fits your pain point to the vertebral endplate as the pain source. That has its own treatment options, including basivertebral nerve ablation (Intracept). Type 2 or 3 changes do not carry those in the same way. Diagnosis comes first, then the treatment that fits it.
Sources
- Dudli S et al. Pathobiology of Modic changes. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2016. PubMed 26914098
- Hopayian K et al. The association of modic changes and chronic low back pain: A systematic review. Journal of orthopaedics, 2023. PubMed 36438174
- Udby PM et al. A definition and clinical grading of Modic changes. Journal of orthopaedic research : official publication of the Orthopaedic Research Society, 2022. PubMed 34910328
- Ahmadifard H et al. Prevalence of modic changes in patients with low back pain and association with degenerative spinal findings: a retrospective MRI study. BMC musculoskeletal disorders, 2025. PubMed 41219765
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