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Harrison 09-13-2007 06:46 AM

As so many people appear to have multilevel disc disease, I thought it would be interesting to start a short survey which tracks this sad issue. Please respond to the question below, and feel free to comment as well.

When you read the question, please think about your past and present condition. E.g., if you had 3 levels replaced, and all your other spine segments are "good," then choose "Three Levels."

Please encourage other members here to vote too, I think this will be an interesting survey...

Harrison 09-15-2007 08:56 AM

Just to keep tabs on this informal survey, here are the results so far:

Patients..%..Number of Levels:

4 (19%) One Level
7 (33%) Two Levels
3 (14%) Three Levels
2 (10%) Four Levels
1 (5%) Five Levels
2 (10%) Six Levels
0 (0%) Seven Levels
1 (5%) Eight Levels
0 (0%) Nine Levels
1 (5%) Ten + Levels

So far, roughly half surveyed showed three or more problematic spine levels.

If you are a patient and have not yet voted, please do!

Terry 09-15-2007 12:47 PM

Oh My God! 6, 8, 10+ Levels. We have bionic people wandering around out there!

Seems they don't call it degenerative disc disease for nothing.

Interesting. Sure would be nice to figure out why some have so much pain and others whose MRI's look horrible have no issues.

Doctors treat symptoms rather than causes. What caused us to turn to mush spine?

Terry Newton

Harrison 09-15-2007 04:43 PM


We have bionic people wandering around out there!
Terry some folks who voted have not yet had surgery. The point is to simply demonstrate how widespread multi-level disease is for many people.

Well said, on the question of causes...we need more insights on the root cause of these life-robbing spinal problems!

tmont 09-15-2007 05:13 PM


Interesting. Sure would be nice to figure out why some have so much pain and others whose MRI's look horrible have no issues.


cervie queen 09-15-2007 05:13 PM

I don't post too much, but maybe you could guess that I was the ten level person. I've already had surgery on nine different levels. But then, maybe we should do a survey on age: onset and surgery or present......

Don 09-16-2007 08:55 AM

I've have two theories about my DDD. The truth is probably a blend of both.

1. One level goes bad and we don't fix it, the instability it creates is the first dominoe and the "cause" of the future disc problems?

2. It truly is a disease. The joints just start going bad and until medicine can find the "cause" behind the disease, we are SOL.

I hope they find out before my kids are old!

edited cuz I can't spell, type and think at the same time.....

Harrison 09-17-2007 07:36 AM

Well said, Don. The authors of this recent paper talk about this in more detail -- see below for an interesting viewpoint on these conversations we've been having.

Modic changes, possible causes and relation to low back pain.

1: Med Hypotheses. 2007 Jul 9; [Epub ahead of print]
Albert HB, Kjaer P, Jensen TS, Sorensen JS, Bendix T, Manniche C.
All The Back Research Center, Part of Clinical Locomotion Science, University of Southern Denmark, Lindevej 5, 5750 Ringe, Denmark.

In patients with low back pain (LBP) it is only possible to diagnose a small proportion, (approximately 20%), on a patho-anatomical basis. Therefore, the identification of relevant LBP subgroups, preferably on a patho-anatomical basis, is strongly needed. Signal changes on MRI in the vertebral body marrow adjacent to the end plates also known as Modic changes (MC) are common in patients with LBP (18-58%) and is strongly associated with LBP.

In asymptomatic persons the prevalence is 12-13%. MC are divided into three different types. Type 1 consists of fibro vascular tissue, type 2 is yellow fat, and type 3 is sclerotic bone. The temporal evolution of MC is uncertain, but the time span is years. Subchondral bone marrow signal changes associated with pain can be observed in different specific infectious, degenerative and immunological diseases such as osseous infections, osteoarthritis, ankylosing spondylitis and spondylarthritis. In the vertebrae, MC is seen in relation to vertebral fractures, spondylodiscitis, disc herniation, severe disc degeneration, injections with chymopapain, and acute Schmorl's impressions.

The aim of this paper is to propose two possible pathogenetic mechanisms causing Modic changes. These are: A mechanical cause: Degeneration of the disc causes loss of soft nuclear material, reduced disc height and hydrostatic pressure, which increases the shear forces on the endplates and micro fractures may occur. The observed MC could represent oedema secondary to the fracture and subsequent inflammation, or a result of an inflammatory process from a toxic stimulus from the nucleus pulposus that seeps through the fractures. A bacterial cause: Following a tear in the outer fibres of the annulus e.g. disc herniation, new capilarisation and inflammation develop around the extruded nuclear material. Through this tissue it is possible for anaerobic bacteria to enter the anaerobic disc and in this environment cause a slowly developing low virulent infection. The MC could be the visible signs of the inflammation and oedema surrounding this infection, because the anaerobic bacteria cannot thrive in the highly aerobic environment of the MC type 1.

Perspectives: One or both of the described mechanisms can - if proven - be of significant importance for this specific subgroup of patients with LBP. Hence, it would be possible to give a more precise and relevant diagnosis to 20-50% of patients with LBP and enable in the development of efficient treatments which might be antibiotics, special rehabilitation programmes, rest, stabilizing exercise, or surgical fixation, depending on the underlying cause for the MC.

kanutta 09-18-2007 12:36 PM

There has been a lot of interest in Modic changes at some norwegian spineboards recently.
Several has been diagnosed with it; in addition to degenerative disc disease.
It seems that the patient has to ask specifically for modic changes, they don't tell you if you don't seems to be a relatively new diagnosis, at least here up north.
People have read information about MC on the spineboards, and then go ahead ask their surgeon if they can see any of it...and apaprently it is quite common.
It seems that there is little to be done about it though, no cure...?

Maybe MC is part of the reason that some are still in pain after surgery...

Harrison 09-18-2007 03:59 PM

Thanks Kanutta, for the observations. It is interesting that this type of research (and related topics) seems to be performed in non-U.S. countries. It's peculiar...but at least someone is doing it!

I hope we see more of this -- any isights that can help patients obtain a more detailed diagnostic assessment of their condition.

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