Hvad er Modicforandringer?

Modic forandringer er knogleforandringer i ryghvirvlerne. Dr. Michael Modic opdagede i 1988 disse forandringer, og de er blevet opkaldt efter ham. Han beskrev, hvordan Modic forandringer ser ud på en MR-scanning. Han udtog også prøver af knoglerne, så han kunne beskrive de forandringer der sker i knoglerne.

Normal knogle
En normal knogle i ryghvirvlerne består af en slags stillads af tusindvis af små fine knogletråde. I hulrummene mellem knogletrådene er der rød knoglemarv, der producerer blodlegemer.

Figur 1: Knoglestruktur i en normal ryghvirvel.

Modicforandringer
Ved Modicforandringer er knogletrådene brækket massevis af steder, og de er kortere og bredere end i normale knogle. Knoglevævets mønster er ujævnt og uden struktur. Knoglemarven er erstattet af den samme klare væske som i en vabel eller af gult fedt, og der er vokset nye smertenervefibre ind i knoglen.

Figur 2: Eksempel på ødelagt knoglemarv ved Modicforandringer (kilde: http://www.drfryer.ca/)

Hvorfor er det vigtigt at vide noget om Modic forandringer?
Modicforandringer giver smerter ryggen! Talrige undersøgelser har efterhånden vist, at der er klar sammenhæng mellem det at have Modic forandringer i ryghvirvlerne og ondt i ryggen. Modicforandringer ses hyppigst i lænden, men findes også i hvirvlerne i nakken og i brystkassen og giver tilsvarende smerter i de regioner.

Flere undersøgelser har vist, at patienter med Modic forandringer er forskellige fra andre patienter med almindelige rygsmerter. Hvis man ser på forskellene mellem rygsmerter fra Modic forandringer og fra almindelige rygsmerter, så viser undersøgelserne, at smertestyrken hos Modic patienter er væsentligt højere. Desuden har 75 – 80 % af patienter med Modic forandringer konstant ondt. Det betyder, at der ikke er et eneste tidspunkt, i løbet af døgnet, hvor de er smertefrie. Smerter fra Modic forandringer svinger i intensitet i løbet af døgnet, og bortset fra morgensmerter, er smertestyrken ofte afhængig af, hvor meget patienten laver. 68 % af patienterne er så plagede af smerter om natten, at når de skal vende sig i sengen, vågner de på grund af smerterne.

Modic forandringer kan ikke behandles med almindelige behandlingsformer
Det er desværre således, at de behandlingsformer, der normalt er effektive til at fjerne smerterne hos patienter med almindelige rygsmerter, de virker ikke på smertene hos Modic patienter. Normalbehandlingen for ondt i ryggen er målrettede øvelser, der bliver undervist i og superviseret af en fysioterapeut. Efter øvelserne skal patienten ofte følge et længerevarende genoptræningsprogram med styrketræning og træning i fitnesscenter. Denne behandling hjælper ikke patienter med Modic forandringer og normalt oplever patienter, at smerterne ØGES, når eller efter de træner.

Er Modic forandringer en ny diagnose?
Ja, Modic forandringer er en forholdsvis ny diagnose, Modic forandringer blev først beskrevet i 1988. Men mennesker har haft af ondt i ryggen fra Modic forandringer altid. Diagnosen kan kun stilles via en MR scanning. Da MR-scanninger er en forholdsvis ny undersøgelsesmetode, og det er så uheldigt, at Modic forandringer ikke kan ses på røntgenbilleder, så har man ikke tidligere været i stand til at se disse forandringerne.

Er dine rygsmerter “normale rygsmerter,” eller skyldes de Modic forandringer?
Der er mange forskelle mellem patienter med “normale rygsmerter” og patienter med ondt i ryggen pga. Modic forandringer. En af de klassiske forskelle er smertemønsteret. Patienter med “normale rygsmerter” har normalt ondt i ryggen nogle dage eller uger, de er flittige med deres øvelser, eller de får anden behandling, eller venter til tiden heler discus. Resultatet er, at stille og roligt forsvinder smerterne i ryggen. Derefter kan der gå måneder eller år uden smerter, og så pludseligt kommer der en ny periode med ondt i ryggen. Dette er en cyklus, som millioner af mennesker over hele verden oplever. Mønstret med almindelige rygsmerter kan sammenlignes med det at blive forkølet. Det er normalt, at vi alle bliver forkølet en gang imellem, det er rigtig ubehageligt, mens det står på, men alle ved, at forkølelsen går over, og at vi igen bliver sunde og raske. Ligeledes er det med almindelige rygsmerter.

Modsat oplever patienter, der har ondt på grund af Modic forandringer, at de har smerter mere eller mindre konstant. Smerterne variere som regel i løbet af døgnet, og der kan være gode timer, hvor man “glemmer” smerterne. Der kan være perioder på året, hvor smerterne er værre eller bedre, men meget sjældent lange perioder med smertefrihed, sådan som patienter med “normale rygsmerter” har.

Prognose
Uden behandling er prognosen for Modic patienter desværre dårlig og meget langvarig. Modic forandringer kommer meget ofte efter en diskusprolaps (man kan  have en discusprolaps uden af have haft smerter ned i benet). Desværre viser den sidste ny forskning der blev offentliggjort i maj 2014, basseret på et meget stort forskningsprojekt i England at progosen er værrer end tidligere antaget.

Tidligere viden der var bassert på en lille studie der beskrev at Modic forandringerne begyndte som type 1, hvilket man havde i 3-5 år, og der udvikler sig til Modic type 2 i normalt 5-7 år. Så ubehandlet kunne man forvente 10-12 år med smerter. Det nye store studie viser desværre at efter 10 år er Modicforandringerne kun forsvundet hos 3,5 % af patienterne.

Tak fordi du læste med 😊
Kærligst Zinna

Kilde: http://modicklinikken.dk/hvad-er-modic-forandringer

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