Classification of Modic endplate changes in degenerative spine disease

Degenerative vertebral endplate and subchondral bone marrow changes were first noted on MR imaging by de Roos et al in 1987.A formal classification was subsequently provided by Modic et al in 1988, based on a study of 474 patients, most of whom had chronic low back pain (LBP). These authors described 2 types of endplate and marrow changes:


Type 1 changes were hypointense on T1-weighted imaging (T1WI) and hyperintense on T2-weighted imaging (T2WI) and were shown to represent bone marrow edema and inflammation.

Type 2 changes were hyperintense on T1WI and isointense or slightly hyperintense on T2WI and were associated with conversion of normal red hemopoietic bone marrow into yellow fatty marrow as a result of marrow ischemia.

Type 3 changes were subsequently described as hypointense on both T1WI and T2WI and were thought to represent subchondral bone sclerosis.

Mixed-type 1/2 and 2/3 Modic changes have also been reported, suggesting that these changes can convert from one type to another and that they all present different stages of the same pathologic process.

Modic Change
Type 1 :T1 Low T2 High
Type 2 : T1 High T2 High
Type 3 : T1 Low T2 Low