Background: Few studies have characterized the development of Modic changes in the cervical spine over time. We evaluated Modic changes of the cervical spine that developed over a 20-year period in a healthy cohort, and sought to clarify the relationship between Modic changes and the development of clinical symptoms. Methods: For this multicenter prospective cohort study, we recruited 193 subjects from an original cohort of asymptomatic volunteers who underwent MRI of the cervical spine between 1993 and 1996. Each cervical level from C2/3 to C7/T1 (total n = 1158 intervertebral levels) was assessed on current MRIs as normal or showing type 1, 2, or 3 Modic change, and we asked about symptoms related to the cervical spine. Relationships between the presence of Modic changes and patient characteristics, pre-existing disc degenerations or clinical symptoms were evaluated by logistic regression analysis. Results: After 20-year follow-up, Modic changes affected 31 subjects (16.1%) at 47 intervertebral disc levels. Of these 47 intervertebral disc levels, type 2, found at 30 levels (63.8%), was the most frequent, followed by type 1 at 15 levels (31.9%) and type 3 at two levels (4.3%). The most frequent changes were observed at the C5/6 segment with type 2 Modic changes. The presence of Modic changes correlated with pre-existing posterior disc protrusion (odds ratio 3.31, 95% confidence interval 1.21–9.05) and neck pain (odds ratio 2.71, 95% confidence interval 1.08–6.80). Conclusions: In the cervical spine over a 20-year period, type 2 Modic changes were most frequent at the C5/6 segment. The Modic changes were associated with pre-existing disc degeneration and neck pain but not with age, BMI, smoking, shoulder stiffness, arm pain or numbness.
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