# Modic — Modic vertebral endplate marrow changes

> Per-disc-level MRI phenotype of vertebral endplate-adjacent marrow signal: fibrovascular/edematous type 1, fatty type 2 and sclerotic type 3, including mixed patterns. It is a descriptive imaging classification, not proof of infection, a pain generator or a treatment indication.

**Situação:** vigente · **Órgão:** Coluna · **Órgão emissor:** Modic et al. / ISSLS Degenerative Spinal Phenotypes Group · **Versão:** 1988 types 1-3; ISSLS reporting recommendations and evidence through 2026 · **Ano:** 1988

> ⚠️ Uma versão mais nova pode existir (em revisão).

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: MRI
- Fonte primária: Modic MT, Steinberg PM, Ross JS, et al.. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging (1988) — https://doi.org/10.1148/radiology.166.1.3336678
- Última verificação: 2026-07-24
- Última checagem: 2026-08-12

## Lógica de decisão
Classify endplate-adjacent marrow per level from sequence-aware T1/T2 evidence, preserve mixed patterns and dangerous mimics, and never turn a Modic type into pain causality, infection exclusion or an autonomous treatment instruction.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| 1 | Type 1, edematous or inflammatory | At a named disc/endplate level, marrow immediately adjacent to the endplate is low signal on conventional T1-weighted MRI and high signal on conventional non-fat-suppressed T2-weighted MRI relative to normal vertebral marrow. The tissue correlate is endplate disruption/fissuring with water-rich fibrovascular marrow replacement; map cranial/caudal endplate, distribution, extent and any mixed type 2 component. | Report a type 1 or mixed 1/2 phenotype with sequence adequacy and actively check for infection, acute Schmorl node, fracture, inflammatory disease and tumor when morphology or clinical context warrants. The Modic label does not select analgesia, rehabilitation, injection, surgery or antibiotics; suspected infection follows its own urgent diagnostic pathway. | Type 1 is an edematous/fibrovascular imaging phenotype, not proof of painful inflammation or occult infection. Pain associations across studies are inconsistent. The 2019 AIM trial found no clinically important one-year amoxicillin benefit, while a 2026 Cochrane synthesis found only low-certainty small short-term benefits in selected type-1-plus-disc-herniation patients and very uncertain harms; neither supports image-only prescribing. | Modic et al. 1988, DOI 10.1148/radiology.166.1.3336678, abstract/results for low T1/high T2 and fibrovascular tissue; Fields et al. 2019, PMC7205555, reporting recommendations; Herlin et al. 2018, PMC6070210, Results/Conclusions; Bråten et al. 2019, PMC6812614, primary outcome; Liu et al. 2026, DOI 10.1002/14651858.CD014221.pub2, Authors' conclusions. | ✓ |
| 2 | Type 2, fatty | Endplate-adjacent marrow is high signal on conventional T1-weighted MRI and isointense to slightly high signal on conventional non-fat-suppressed T2-weighted MRI, corresponding to fatty yellow-marrow replacement. Fat suppression can make the same tissue dark on fluid-sensitive imaging, so retain the actual sequence context and any mixed type 1 or type 3 component. | Describe the level, both adjacent endplates, extent and mixed pattern, with disc degeneration and endplate defects reported separately. Type 2 does not identify the symptomatic level or dictate conservative care, procedure or surgery; management requires clinical concordance and the complete spine examination. | Type 2 is a fatty degenerative marrow phenotype, not a calibrated stage of pain, disability or future deterioration. It can persist, coexist with type 1 or type 3, or change over time, and it neither excludes another pain generator nor supplies a treatment-response probability. | Modic et al. 1988, DOI 10.1148/radiology.166.1.3336678, abstract/results for high T1, iso/slightly high T2 and fatty replacement; Fields et al. 2019, PMC7205555, sections on sequence effects, mixed phenotypes, measurement and reporting; Herlin et al. 2018, PMC6070210, association limitations. | ✓ |
| 3 | Type 3, sclerotic | Endplate-adjacent marrow is low signal on both conventional T1-weighted and conventional non-fat-suppressed T2-weighted MRI, corresponding to subchondral sclerosis. Corroborating dense sclerosis on CT or radiographs supports the interpretation; low signal only on fat-suppressed T2/STIR is insufficient because fat is also suppressed there. | Report type 3 at the exact level with extent, endplate morphology and any mixed type 2 component. CT or radiographs may clarify sclerosis, but the type itself does not require intervention or identify a pain generator; address fracture, destructive lesion or other competing diagnosis on its own evidence. | Type 3 is an uncommon sclerotic phenotype, not a validated end-stage prognosis and not evidence that symptoms are irreversible. A pure or mixed type 3 category does not predict pain severity, fracture, cancer, progression rate or benefit from surgery. | Modic et al. 1988, Imaging of degenerative disk disease, DOI 10.1148/radiology.168.1.3289089, type 3 low-T1/low-T2 sclerotic pattern; Fields et al. 2019, PMC7205555, sequence/reporting recommendations and mixed phenotypes. | ✓ |

### Citações por categoria
- **1**: Modic MT, Steinberg PM, Ross JS, et al.. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging (1988) — https://doi.org/10.1148/radiology.166.1.3336678 · Modic et al. 1988, DOI 10.1148/radiology.166.1.3336678, abstract/results for low T1/high T2 and fibrovascular tissue; Fields et al. 2019, PMC7205555, reporting recommendations; Herlin et al. 2018, PMC6070210, Results/Conclusions; Bråten et al. 2019, PMC6812614, primary outcome; Liu et al. 2026, DOI 10.1002/14651858.CD014221.pub2, Authors' conclusions.
- **2**: Modic MT, Steinberg PM, Ross JS, et al.. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging (1988) — https://doi.org/10.1148/radiology.166.1.3336678 · Modic et al. 1988, DOI 10.1148/radiology.166.1.3336678, abstract/results for high T1, iso/slightly high T2 and fatty replacement; Fields et al. 2019, PMC7205555, sections on sequence effects, mixed phenotypes, measurement and reporting; Herlin et al. 2018, PMC6070210, association limitations.
- **3**: Modic MT, Steinberg PM, Ross JS, et al.. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging (1988) — https://doi.org/10.1148/radiology.166.1.3336678 · Modic et al. 1988, Imaging of degenerative disk disease, DOI 10.1148/radiology.168.1.3289089, type 3 low-T1/low-T2 sclerotic pattern; Fields et al. 2019, PMC7205555, sequence/reporting recommendations and mixed phenotypes.

## Referências cruzadas
- _fronteira compartilhada_ → [Pfirrmann — Pfirrmann grading of lumbar disc degeneration](https://radcommons.laudos.ai/systems/pfirrmann.md) — Both grade degenerative lumbar spine MRI: Modic for endplate and marrow changes, Pfirrmann for disc degeneration.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2026-08-01 | revised | Monitored source changed (version_regex). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-24 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | dismissed |
| 1988-07-01 | revised | The companion imaging paper described the low-T1 and low-T2 sclerotic type 3 phenotype, completing the commonly used three-type map. | confirmed |
| 1988-01-01 | published | Modic and colleagues published the original type 1 and type 2 vertebral endplate marrow signal phenotypes. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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