draining into the vertebral body, and causing an autoimmune reaction. This mechanical theory is supported by the fact that histological findings of the Modic Changes demonstrate disruption of the endplates with evidence of chronic inflammation. This in turn suggests that this erosion weakens the bone matrix, giving rise to stress fractures and consequent oedema, the universal reaction of bone under stress seen in fractures wherever they occur and always associated with pain. Prevalence Modic changes have been observed in approximately 6% of the general adult population regardless of ethnicity. Modic changes are rare in children and young adults. From the age of 25 to 40 years, there is a steep increase in their prevalence, which levels out about 40 years of age and is stable until 80+ years. Modic changes are estimated to affect approximately 349 million of the adult population worldwide.[July 2021 est.] Modic changes do not disappear The natural development of Modic changes was observed in an extensive study of almost 800 English twins. These twins had an initial MRI diagnosing them with Modic changes and another MRI 10 years later. No treatment was given, thus only observing the development of Modic changes. The study showed that only 3.5% of the people who had Modic changes initially demonstrated that they had disappeared after ten years. Unfortunately, most of the Modic changes do not resolve spontaneously. Diagnosing Modic changes Modic changes are observed on MRI (magnetic resonance imaging) scans. Bone oedema in other bones is not categorized into different types, but Dr. Michael Modic was the first to classify, describe and define Modic changes into three types. The different types were first described and defined in 1988. Normal bone contains internal scaffolding, called trabeculae. Red bone marrow, which produces blood cells, is located in the hollows between the trabeculae. Modic changes Type 1 reflects oedema adjacent to the disc, fissured endplates, microfractures of the trabeculae, granular tissue, high levels of immunoreactive nerve fibers, and TNF alpha cells (pro-inflammatory) Modic changes Type 2 contains high levels of fat associated with degeneration of the bone marrow, microfractures of the trabeculae, disruption of the endplates, and immunoreactive nerve fibers and TNF alpha cells. A mix of Type 1 and Type 2 have frequently been observed in the exact Modic change. Modic Change type 3 is rare and suggests a more stable sclerotic phase. The proof of an ongoing pathologic process in a