Dynamic Stabilisation in the Treatment of Degenerative Disc Disease with Modic Changes

Abstract

Objective. Posterior dynamic stabilization is an effective alternative to fusion in the treatment of chronic instability and degenerative disc disease (DDD) of the lumbar spine. This study was undertaken to investigate the efficacy of dynamic stabilization in chronic degenerative disc disease with Modic types 1 and 2. Modic types 1 and 2 degeneration can be painful. Classic approach in such cases is spine fusion. We operated 88 DDD patients with Modic types 1 and 2 via posterior dynamic stabilization. Good results were obtained after 2 years of followup. Methods. A total of 88 DDD patients with Modic types 1 and 2 were selected for this study. The patients were included in the study between 2004 and 2010. All of them were examined with lumbar anteroposterior (AP) and lateral X-rays. Lordosis of the lumbar spine, segmental lordosis, and ratio of the height of the intervertebral disc spaces (IVSs) were measured preoperatively and at 3, 12, and 24 months after surgery. Magnetic resonance imaging (MRI) analysis was carried out, and according to the data obtained, the grade of disc degeneration was classified. The quality of life and pain scores were evaluated by visual analog scale (VAS) score and Oswestry Disability Index (ODI) preoperatively and at 3, 12, and 24 months after surgery. Appropriate statistical method was chosen. Results. The mean 3- and 12-month postoperative IVS ratio was significantly greater than that of the preoperative group (P < 0.001). However, the mean 1 and 2 postoperative IVS ratio was not significantly different (P > 0.05). Furthermore, the mean preoperative and 1 and 2 postoperative angles of lumbar lordosis and segmental lordosis were not significantly different (P > 0.05). The mean VAS score and ODI, 3, 12, and 24 months after surgery, decreased significantly, when compared with the preoperative scores in the groups (P = 0.000). Conclusion. Dynamic stabilization in chronic degenerative disc disease with Modic types 1 and 2 was effective.

Resultados en el tratamiento quirúrgico de hernia discal lumbar, reporte a siete años de seguimiento

“…En este estudio la mayoría de los pacientes antes de someterse al procedimiento de estabilización dinámica fueron valorados con escala Modic dentro del tipo II y I, y a pesar de que esta condición persistió en el postquirúrgico no hubo correlación con evolución clínica y funcional favorables como en lo descrito por Olcay Eser. 13 Con el tema de artroplastía existe un reporte 14 con un seguimiento a cuatro años, en el que hay una mejora en las condiciones clínicas y radiográficas de los pacientes así como aumento de la altura del espacio intersomático; refiere una mejoría de 35% en escala de Oswestry. Nosotros observamos en este estudio que hubo una mejoría de 32.6%, siendo muy similar a lo reportado, pero con una disminución de la altura del espacio intersomático de 0.55 mm.…”

Enlargement of Neural Foramina and Dynamic Stabilization in Spondylolisthesis without Restoring the Alignment: Technical Note

“…Hospital cost is also low than fusion operations. The dynamic stabilization instead of fusion also prevents the risks pseudoarthrosis and adjacent segment disease in these patients 3) . We believe that this procedure is suitable as an alternative surgical technique in patients who have degenerative spondylolisthesis or low-grade dysplastic type spondylolisthesis with radicular signs secondary to nerve root compression in decreased neural foramina.…”

Transforaminal Epiduroscopic Basivertebral Nerve Laser Ablation for Chronic Low Back Pain Associated with Modic Changes: A Preliminary Open-Label Study

“…A recent study showed that, in nonspecific low back pain (LBP), the prevalence of any type of Modic change was 46%, as opposed to 6% in the general population [ 10 – 13 ]. Most individuals with Modic changes of more than 90% on MRI will have back pain within one year [ 8 , 13 , 14 ].…”