"Modic type 1 endplate change is the most controversial and important of the three types described (see Modic endplate change). It is seen on MRI of the spine and represents the presence of low T1 and high T2 signal within the bone marrow of a vertebral body adjacent to a disk. Type 1 change can enhance and be painful."
"This pattern is very similar to that seen in infection and merely represents bone marrow oedema. Without correlation with clinical parameters (symptoms, fever, inflammatory markers) it can be difficult to distinguish sterile Modic type 1 change from discitis/osteomyelitis. Highlighting this difficulty is the finding that a proportion of patients with what appears to be 'incidental' Modic type I change will go on to have proven discitis/osteomyelitis by low virulence pathogens such as Staphylococcus epidermidis, Propionibacterium acnes, and diphtheroid species over protracted follow-up (4.2% over 2 year follow-up in one study 3)."
"More controversial is a 2013 study 4 which suggested that patients with isolated Modic 1 changes on imaging with only chronic lower back pain as a symptom (and no clinical or laboratory evidence of infection) responded clinically to protracted antibiotic administration with statistically significant improvement in disease-specific disability-RMDQ, leg pain and lumbar pain 4. The authors have coined the term Modic Antibiotic Spinal Therapy (MAST)."
"The classification was introduced by Michael T Modic and colleagues in 1988 2. Michael T Modic (fl. 2024) is an American neuroradiologist at the Vanderbilt University Medical Centre in Nashville, Tennessee, in the US, although almost the whole of his career prior to 2018 was spent at the Cleveland Clinic."
"History and etymology"