Clinical Consultation 

From:  William J Owens Jr DC DAAMLP

Understanding the difference between and ACUTE or CHRONIC injury to the spine is a critical part of proper spine care.  One of the ways to do that is to use the Modic scale to determine how long a reactive process has been present in the spine.  

Here is a very brief reference sheet to help you.  REMINDER – you need to review BOTH the T1 and the T2 weighted images to determine the Modic criteria.  

Modic type endplate changes represent a classification for vertebral body end-plate MRI signal, first described in 1988 1. It is widely recognised by radiologists and clinicians and is a useful shorthand for reporting MRIs of the spine.

Recently Modic type I has received renewed attention due to the possibility of it representing low grade indolent infection. It is thus discussed separately here.

  • Modic type I – typically ranges from instant (d/t trauma) to 18 months 
    • T1: low signal
    • T2: high signal
    • represents bone marrow oedema and inflammation
    • T1+C: enhancement
  • Modic type II – typically ranges from 18-24 months 
    • T1: high signal
    • T2: iso to high signal
    • represents normal red haemopoietic bone marrow conversioninto yellow fatty marrowas a result of marrow ischaemia
  • Modic type III – typically greater than 24 months 
    • T1: low signal
    • T2: low signal
    • representssubchondral bony sclerosis

Diagnosing modic changes[edit]

Modic changes are characterized on MRI (magnetic resonance imaging). The 3 Modic classifications were first described and defined by Dr. Michael Modic in 1988.
Normal bone contains internal scaffolding, called trabeculaeRed bone marrow, which produces blood cells, is located in the hollows between the trabeculae.
  • In Modic type 1 there is vascular development in the vertebral body, with findings of inflammation and edema, but no trabecular damage or marrow changes.
  • In Modic type 2 there are changes in bone marrow, with fatty replacement of formerly red, cellular marrow normally seen there. With Modic type 2 changes the marrow is substituted by visceral fat, the same kind of fat we have on our hips and bellies.
  • Modic Changes type 3 are less common, with fractures of the trabecular bone, along with trabecular shortening and widening.


  • Modic MT, Steinberg PM, Ross JS, et al. (1988). “Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging”. Radiology166 (1): 193–9. PMID 3336678doi:10.1148/radiology.166.1.3336678.


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