Effectiveness of Epidural Steroid Injections and Facet Joint Blocks in Alleviating Persistent Low Back Pain: A Comparison of Patients With and Without Modic Changes

Background: Modic changes (MCs) are magnetic resonance imaging (MRI) signal alterations in vertebral endplates associated with degenerative lumbar spine disorders and low back pain (LBP). Their clinical significance in response to nonsurgical modalities, such as epidural steroid injections (ESIs) and facet joint blocks (FJBs), remains controversial. This study investigates the impact of MCs on treatment outcomes in chronic LBP. This work aims to compare clinical outcomes of nonsurgical treatment with ESIs and FJBs in patients with and without MCs, and to assess the influence of different Modic types on pain and functional improvement. Methods: This prospective study was conducted in the Neurosurgery Department at Zagazig University Hospitals between January and December 2024. A total of 48 patients with chronic LBP (≥12 weeks) and degenerative lumbar spine disease were divided into two groups: with MCs (n = 24) and without MCs (n = 24). Each group was further subdivided into two subgroups (ESI and FJB; n = 12 per subgroup). Patients were evaluated using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) at baseline, 6 weeks, and 12 weeks after the injection. Results: Baseline demographics and clinical characteristics were comparable between groups. At 12 weeks, patients with MCs had worse pain and functional outcomes compared to those without. In the Modic group, ESI patients had the highest mean VAS (7.33 ± 0.82) and ODI (52.4 ± 7.1), whereas the non-Modic FJB subgroup had the lowest mean VAS (5.83 ± 0.75) and ODI (34.2 ± 6.3). Among non-Modic patients, outcomes were similar between ESI and FJB (VAS: 5.83 ± 0.98 vs. 5.83 ± 0.75; ODI: 36.1 ± 5.9 vs. 34.2 ± 6.3; p > 0.999). In Modic patients, ESI exhibited higher mean VAS and ODI than FJB (VAS: 7.33 ± 0.82 vs. 6.33 ± 1.03; ODI: 52.4 ± 7.1 vs. 42.7 ± 6.8) (p = 0.092 for VAS, p = 0.093 for ODI). Median VAS percent change confirmed the pattern: Modic ESI patients worsened (+14.3%), whereas non-Modic FJB patients improved the most (–14.1%, p = 0.011). Conclusion: MCs negatively affect the efficacy of nonsurgical interventions for LBP. Patients with MCs, particularly those receiving ESI, are less likely to achieve significant pain relief and functional improvement. These findings suggest that Modic-positive patients may benefit from individualized treatment strategies, with FJB potentially offering better outcomes than ESI. Further investigations on larger sample sizes and longer follow-up are needed to confirm these results.