Lumbar Disc Herniation and Preoperative Modic Changes: A Prospective Analysis of the Clinical Outcomes After Microdiscectomy

Abstract

Study design: Prospective comparative cohort study. Objectives: The study aims to elucidate the relationship between Modic endplate changes and clinical outcomes after a lumbar microdiscectomy. Methods: Consecutive patients undergoing microdiscectomy for lumbar disc herniation (LDH) were prospectively studied. Pre-operative clinical and radiological parameters were recorded. The pain was assessed by Numeric pain rating scale (NPRS), and functional assessment by Oswestry Disability Index (ODI). Minimal clinically important difference (MCID) in outcome was calculated for both the groups. Complications related to surgery were studied. Follow-up was done at 6 weeks, 3 months, 6 months and 1 year. Mac Nab criteria were used to assess patient satisfaction at 1 year. Results: Out of 309 patients, 86 had Modic changes, and 223 had no Modic changes. Both groups had similar back pain (p-value: 0.07) and functional scores (p-value: 0.85) pre-operatively. Postoperatively patients with Modic changes had poorer back pain and ODI scores in the third month, sixth month and 1 year (p-value: 0.001). However, MCID between the groups were not significant (p-value: 0.18 for back pain and 0.58 for ODI scores). Mac Nab criteria at 1 year were worse in Modic patients (p-value: 0.001). No difference was noted among Modic types in the pre-operative and postoperative pain and functional outcomes. Four patients in Modic group (4.7%) and one patient in the non-Modic group (0.5%) developed postoperative discitis (p-value: 0.009). Conclusions: Preoperative Modic changes in lumbar disc herniation is associated with less favorable back pain, functional scores and patient satisfaction in patients undergoing microdiscectomy.

Evaluating the Impact of Modic Changes on Operative Treatment in the Cervical and Lumbar Spine: A Systematic Review and Meta-Analysis

“…Kumarasamy et al [ 21 ] prospectively followed 309 patients undergoing microdiscectomy, 86 of whom had MC. The patients in the MC group had worse postoperative numeric rating scale (NRS) back pain (1.6 to 1.1, p = 0.001), although the overall improvement in both groups was 4.3 points, indicating that there was no difference in the magnitude of overall improvement.…”

“…Five studies reported values for ODI [ 21 , 23 , 44 , 45 , 50 ], and four studies reported VAS back pain [ 21 , 44 , 45 , 50 ]. A meta-analysis was performed among these studies and identified no significant associations between MC and either postoperative VAS back pain or ODI ( Figure 3 ).…”

“…While discectomy and microdiscectomy overall appear efficacious as a treatment for axial back pain reduction and PRO improvement for patients with MCs, those with type I MC may experience reduced improvements following discectomy. Only one study evaluating microdiscectomy identified worse improvement in patients with MCs, although this was not clinically significant [ 21 ]. Two other retrospective studies identified a relationship between MC and worse PRO improvement (ODI and VAS back) following discectomy.…”

“…While they found a trend toward worse improvement in lumbar discectomy patients who had MCs, they concluded that it was unlikely that the difference met the minimal clinically important difference (MCID) threshold [ 19 ]. However, no previous study has performed a meta-analysis on patients undergoing cervical spine surgery, and additional literature has been published on patients with MCs undergoing lumbar discectomy since 2016 [ 20 , 21 , 22 , 23 ]. Therefore, our objective was to evaluate the impact of MCs on neck and back pain in patients undergoing cervical or lumbar spine surgery.…”

Non-surgical therapy for the treatment of chronic low back pain in patients with Modic changes: A systematic review of the literature

“…MCs are the specific imaging manifestations characterized by CLBP as a clinical feature [ 39 ]. The underlying mechanism remains unclear and debated (mechanical, local infection, genetic) [ 40 , 41 , 42 ]. For patients with MCs, the clinical approach remains based on the treatment principles of CLBP, with a focus on reducing pain intensity.…”