Benign low back pain is frequent in the lucratively active population. Degenerative changes are considered the most frequent causes. The identification of pain generators remain challenging. Bone marrow lesions, Modic changes, are frequently associated with benign low back pain, mostly type 1. The etiology of Modic changes is unknown, both infectious and autoimmune mechanisms have been suggested. Despite the strong association of Modic changes with low back pain it is not clear whether lumbar surgery (lumbar fusion, total disc replacement) has any role in the management of these patients. We conclude that all available evidence in literature is inconclusive and future studies are needed addressing more precisely the question of minimal clinically important difference (MCID) while considering of all confounding factors influencing outcome.