In 1987, De Roos et al.1 found that there was a band-like or focal high signal region near the endplate of degenerative intervertebral discs on magnetic resonance imaging (MRI), which was different from the signals of tumors and infections. Modic et al.2,3 further described this kind of signal change and divided modic changes (MCs) into 3 types on the basis of the signals on T1WI and T2WI. Endplate edema, bone marrow steatosis, and endplate sclerosis were considered characteristics of type I MC (MC1), type II MC (MC2), and type III MC (MC3), respectively.

However, the cause of MCs has remained unclear. These findings may be closely related to mechanical factors, autoimmune factors, low virulence infection factors, and genetic factors.4, 5, 6, 7, 8, 9 Spinal deformity, intervertebral disc degeneration, injury of the spine, endplate lesion, smoking status, obesity, and high occupational load are all common risk factors for MCs.10,11

Kuisma et al.12 retrospectively reviewed the MRI and computed tomography (CT) data of the lumbar spine of 70 patients. The authors found that endplate sclerosis existed not only in MC3 but also in all kinds of MCs. Liu et al.13 retrospectively reviewed 1023 patients with lumbar degenerative disease and found 1044 endplates with MCs. Among them, endplate sclerosis was discovered in 15.8% of the endplates in MC1, 24.8% of the endplates in MC2, and all the endplates in MC3. However, Hebelka et al.14 also demonstrated that endplate sclerosis was a common type of endplate lesion and was present in 9.4% of the endplates with no modic changes. Endplate sclerosis was not synonymous with MC3.

Wei BX and Wu H15 analyzed the MRI of five-hundred patients with low back patient from outpatient clinic and found that MCs were highly associated with lumbar degenerative disease (including lumbar disc herniation, lumbar stenosis, and lumbar spondylolisthesis) and low back pain. Lawan et al.16 performed a systematic review and meta-analysis concerning the relationship between endplate defects (including endplate sclerosis) and low back pain, and they demonstrated that endplate sclerosis was significantly related to low back pain. Both MCs and endplate sclerosis were related to low back pain and lumbar degenerative disease. However, the relationship between MCs and endplate sclerosis is still unclear. The aim of this network meta-analysis was to explore the relationship between MCs and endplate sclerosis in patients with lumbar degenerative disease.