Inflammation and macrophage polarization are associated with Modic change type in lumbar radiculopathy
Introduction: Lumbar disc herniation (LDH) typically manifests as sciatica, attributed to nerve root mechanical compression and/or inflammation. Modic changes (MC), classified as type I or type II, are deemed to represent endplate vascular insufficiency and are hypothesized to create an inflammatory...
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Elsevier
2025-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529425000682 |
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| author | Wensen Li Niek Djuric Christiaan Mink Carmen L.A. Vleggeert-Lankamp |
| author_facet | Wensen Li Niek Djuric Christiaan Mink Carmen L.A. Vleggeert-Lankamp |
| author_sort | Wensen Li |
| collection | DOAJ |
| description | Introduction: Lumbar disc herniation (LDH) typically manifests as sciatica, attributed to nerve root mechanical compression and/or inflammation. Modic changes (MC), classified as type I or type II, are deemed to represent endplate vascular insufficiency and are hypothesized to create an inflammatory environment. Macrophages infiltrating disc tissue can be polarized into pro-inflammatory M1 or anti-inflammatory M2 phenotypes. Research question: This study aims to investigate the interplay among inflammatory cells, including M1 and M2 macrophages, Modic Changes, and hernia size and type in patients suffering from sciatica due to a LDH. Material and methods: This prospective cohort study selected patients undergoing microdiscectomy for LDH. Macrophage infiltration (CD68, CD192, CD163), MC classification on MRI, and hernia parameters were analyzed. Results: 132 out of 187 patients demonstrated macrophages in the lumbar disc tissue. Most samples demonstrated severe inflammation (50 %), and most macrophages were of the M1 phenotype (48 %). MC were present in 45 % of patients, and only 19 % of these demonstrated MC type I. MC type I were highly associated with both severe (p = 0.016) and M1 macrophage-dominant inflammation (p = 0.048). Larger and non-contained herniations associated with increased inflammation (p = 0.029/p = 0.002), while larger herniations associated with the presence of MC type II (p = 0.027). Discussion and conclusions: This study elucidates a close association of MC type I and M1 macrophage. MC type II were observed more often in patients with larger HNPs. This is indicative for MC typing as an important factor in prediction modelling and it suggests the potential for personalized treatment strategies. |
| format | Article |
| id | doaj-art-e4d3e8719c134ec798ffad18cd005915 |
| institution | DOAJ |
| issn | 2772-5294 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain and Spine |
| spelling | doaj-art-e4d3e8719c134ec798ffad18cd0059152025-08-20T03:05:22ZengElsevierBrain and Spine2772-52942025-01-01510424910.1016/j.bas.2025.104249Inflammation and macrophage polarization are associated with Modic change type in lumbar radiculopathyWensen Li0Niek Djuric1Christiaan Mink2Carmen L.A. Vleggeert-Lankamp3Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Hoofddorp, Haarlem, the Netherlands; Corresponding author. J11-R-83, Department of Neurosurgery, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, the Netherlands.Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Hoofddorp, Haarlem, the NetherlandsNeurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Hoofddorp, Haarlem, the NetherlandsNeurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Hoofddorp, Haarlem, the Netherlands; Spaarne Gasthuis, Hoofddorp, Haarlem, the NetherlandsIntroduction: Lumbar disc herniation (LDH) typically manifests as sciatica, attributed to nerve root mechanical compression and/or inflammation. Modic changes (MC), classified as type I or type II, are deemed to represent endplate vascular insufficiency and are hypothesized to create an inflammatory environment. Macrophages infiltrating disc tissue can be polarized into pro-inflammatory M1 or anti-inflammatory M2 phenotypes. Research question: This study aims to investigate the interplay among inflammatory cells, including M1 and M2 macrophages, Modic Changes, and hernia size and type in patients suffering from sciatica due to a LDH. Material and methods: This prospective cohort study selected patients undergoing microdiscectomy for LDH. Macrophage infiltration (CD68, CD192, CD163), MC classification on MRI, and hernia parameters were analyzed. Results: 132 out of 187 patients demonstrated macrophages in the lumbar disc tissue. Most samples demonstrated severe inflammation (50 %), and most macrophages were of the M1 phenotype (48 %). MC were present in 45 % of patients, and only 19 % of these demonstrated MC type I. MC type I were highly associated with both severe (p = 0.016) and M1 macrophage-dominant inflammation (p = 0.048). Larger and non-contained herniations associated with increased inflammation (p = 0.029/p = 0.002), while larger herniations associated with the presence of MC type II (p = 0.027). Discussion and conclusions: This study elucidates a close association of MC type I and M1 macrophage. MC type II were observed more often in patients with larger HNPs. This is indicative for MC typing as an important factor in prediction modelling and it suggests the potential for personalized treatment strategies.http://www.sciencedirect.com/science/article/pii/S2772529425000682Intervertebral disc herniationLumbarInflammationMacrophageM1 and M2Modic changes |
| spellingShingle | Wensen Li Niek Djuric Christiaan Mink Carmen L.A. Vleggeert-Lankamp Inflammation and macrophage polarization are associated with Modic change type in lumbar radiculopathy Brain and Spine Intervertebral disc herniation Lumbar Inflammation Macrophage M1 and M2 Modic changes |
| title | Inflammation and macrophage polarization are associated with Modic change type in lumbar radiculopathy |
| title_full | Inflammation and macrophage polarization are associated with Modic change type in lumbar radiculopathy |
| title_fullStr | Inflammation and macrophage polarization are associated with Modic change type in lumbar radiculopathy |
| title_full_unstemmed | Inflammation and macrophage polarization are associated with Modic change type in lumbar radiculopathy |
| title_short | Inflammation and macrophage polarization are associated with Modic change type in lumbar radiculopathy |
| title_sort | inflammation and macrophage polarization are associated with modic change type in lumbar radiculopathy |
| topic | Intervertebral disc herniation Lumbar Inflammation Macrophage M1 and M2 Modic changes |
| url | http://www.sciencedirect.com/science/article/pii/S2772529425000682 |
| work_keys_str_mv | AT wensenli inflammationandmacrophagepolarizationareassociatedwithmodicchangetypeinlumbarradiculopathy AT niekdjuric inflammationandmacrophagepolarizationareassociatedwithmodicchangetypeinlumbarradiculopathy AT christiaanmink inflammationandmacrophagepolarizationareassociatedwithmodicchangetypeinlumbarradiculopathy AT carmenlavleggeertlankamp inflammationandmacrophagepolarizationareassociatedwithmodicchangetypeinlumbarradiculopathy |