Modic Changes (MCs) Associated with Endplate Sclerosis Can Prevent Cage Subsidence in Oblique Lumbar Interbody Fusion (OLIF) Stand-Alone

Liu, Junhui; Ding, Wenyuan; Yang, Dalong; Wu, Hao; Lü, Hao; Hu, Zhijun; Fan, Shunwu; Zhao, Fengdong

doi:10.1016/j.wneu.2020.02.047

Cited by 38 publications

(23 citation statements)

References 25 publications

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“…In a retrospective study by Wang 94 involving patients undergoing trans-foraminal lumbar fusion, it was concluded that although presence of MC did not negatively influence fusion rates, cage subsidence rates were greater in those with both Modic's I and II lesions. Liu et al 91 demonstrated that patients with MC and endplate sclerosis had significantly reduced cage subsidence following oblique lumbar inter-body fusion. In a prospective, multicenter, trial involving patients undergoing "lumbar decompression-alone" or "lumbar decompression with fusion", Ulrich 92 reported no significant difference in post-operative clinical outcome (until 36 months postoperatively) between patients with MC and those without MC.…”

Section: And Surgical Treatmentmentioning

confidence: 99%

Modic changes - An evidence-based, narrative review on its patho-physiology, clinical significance and role in chronic low back pain

Viswanathan

Shetty

Rajasekaran

2020

Journal of Clinical Orthopaedics and Trauma

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Objective: Lumbar degenerative spinal ailments are the most important causes for chronic low back pain. Modic changes (MC) are vertebral bone marrow signal intensity changes seen on MRI, commonly in association with degenerative disc disease (DDD). Despite being widely studied, majority of issues concerning MC are still controversial. The current narrative, evidence-based review comprehensively discusses the various aspects related to MC. Literature search: An elaborate search was made using keywords "Modic changes", "lumbar Modic changes", "Modic changes in lumbar spine", and "vertebral Endplate Spinal Changes", on pubmed and google (scholar.google.com) databases on the 3rd of March 2020. We identified crucial questions regarding Modic changes and included relevant articles pertaining to these topics for this narrative review. Results: The initial search using the keywords "Modic changes", "lumbar Modic changes", "Modic changes in lumbar spine", and "vertebral Endplate Spinal Changes" on pubmed yielded a total of 568, 412, 394 and 216 articles on "pubmed" database, respectively. A similar search using the aforementioned keywords yielded a total of 3650, 3548, 3726 and 21570 articles on "google scholar" database. The initial screening involved exclusion of duplicate articles, articles unrelated to MC, animal or other non-clinical studies, and articles in non-English literature based on abstracts or the titles of articles. This initial screening resulted in the identification of 405 articles. Full manuscripts were obtained for all these selected articles and thoroughly scrutinised at the second stage of article selection. All articles not concerning Modic changes, not pertaining to concerned questions, articles concerning other degenerative phenomena, articles discussing cervical or thoracic MC, case reports or animal studies, articles in non-English language and duplicate articles were excluded. Review articles, randomised controlled trials and level 1 studies were given preference. Overall, 69 articles were included in this review. Conclusion: Modic change (MC) is a dynamic phenomenon and its true etiology is still not definitely known. Disc/end plate injury, occult discitis and autoimmune reactions seem to trigger an inflammatory cascade, which leads to their development. Male sex, older age, diabetes mellitus, genetic factors, smoking, obesity, spinal deformities, higher occupational loads and DDD are known risk factors. There is no conclusive evidence on the causative role of MC in chronic low back pain (LBP) or any influence on the long term outcome in patients with LBP or lumbar disc herniations (LDH). Patients with MC have been reported to have less satisfactory outcome following conservative treatment or discectomy, although the evidence is still unclear.

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Section: And Surgical Treatmentmentioning

confidence: 99%

Modic changes - An evidence-based, narrative review on its patho-physiology, clinical significance and role in chronic low back pain

Viswanathan

Shetty

Rajasekaran

2020

Journal of Clinical Orthopaedics and Trauma

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“…Some studies showed that MCs inhibit the process of fusion, as fusion rate after posterior interbody fusion was lower in patients with MCs. In contrast, other studies have shown good fusion results in patients with MCs [ 11 – 15 ].…”

Section: Introductionmentioning

confidence: 84%

Clinical and radiographic outcomes of hybrid graft in patients with Modic changes undergoing transforaminal lumbar interbody fusion

Jiao

Luo

et al. 2021

J Orthop Surg Res

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Background This retrospective study aimed to analyze the influence of Modic changes (MCs) on the clinical and radiographic outcomes of transforaminal lumbar interbody fusion with hybrid graft. Methods Clinical data of 89 patients with Modic changes who underwent single-segment transforaminal lumbar interbody fusion between January 2015 and January 2019 at our institution were analyzed. Patients were divided into three groups: the MCs-0 group (no endplate changes; used as the control group), the MCs-1 group, and the MCs-2 group. Clinical and radiological parameters were compared between the three groups. Results There were no significant between-group differences in age (P = 0.216), sex (P = 0.903), body mass index (P = 0.805), smoking (P = 0.722), diagnosis (P = 0.758), surgical level (P = 0.760), blood loss (P = 0.172), operative time (P = 0.236), or follow-up (P = 0.372). Serum C-reactive protein level and erythrocyte sedimentation rate in the MCs-1 and MCs-2 groups were significantly higher than those in the MCs-0 group on the third and seventh days (P < 0.05). Postoperative radiographic parameters were significantly higher than preoperative parameters in all 3 groups (P < 0.05). Visual analog scale scores for low back pain in the MCs-0 and MCs-2 groups were significantly different from those in the MCs-1 group (P < 0.05). However, there were no significant between-group differences with respect to Oswestry Disability Index scores or visual analog scale scores for leg pain. Conclusion In this study, Modic changes had no impact on fusion rates and clinical outcomes of transforaminal lumbar interbody fusion with hybrid graft (autologous local bone graft plus allogeneic freeze-dried bone graft). However, MCs-1 increased the risk of cage subsidence and showed superior outcomes in terms of visual analog scale scores for low back pain.

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“…CS is one of the most common postoperative complications in lumbar interbody fusion, which is correlated with adverse patient outcomes, such as recurrent low back pain and neurological symptoms, internal fixation failure and an increase in the reoperation rate. [ 10 , 11 , 26 ] Therefore, identification of risk factors for CS after LIF will provide best practices for the assessment of risk factors and postsurgical preventive/clinical interventions for CS. A systematic review and meta-analysis presented in our protocol will identify, collect, evaluate and integrate the existing knowledge in the risk factors and prevalence of CS.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors for cage subsidence after lumbar interbody fusion

Long

Shi

et al. 2021

Medicine

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Introduction: Lumbar interbody fusion (LIF) is an effective treatment for lumbar degenerative diseases. Cage subsidence (CS) contitutes one of the most common postoperative complications. Many risk factors for CS after LIF have been reported in some studies. However, controversies still exist. The objective of this study will be to summarize data on the prevalence and risk factors of CS after LIF. Methods and analysis: Our study present a protocol that conducted a systematic review and meta-analysis of prevalence and risk factors for CS after LIF. Two reviewers retrieved the relevant articles using the 5 databases (PubMed, Scopus, EMBASE, Cochrane Library, and Web of Science) from inception to May 31st, 2021. Primary outcome will be the prevalence of CS after LIF. Second outcomes include the risk factors associated with postoperative CS and clinical outcomes associated with postoperative CS. Three reviewers will screen citation titles and abstracts and evaluated full-text of each potentially relevant citation, and then extracted the data using a data extraction form. Any discrepancies in decisions between reviewers will be resolved through discussion. We assessed the methodological quality and risk of bias of the included studies based on the Newcastle–Ottawa Quality Assessment Scale (NOS). The aim of the extra analysis is to explore the explanations of the heterogeneity (age, gender, race, year of publication, type of study and surgical procedure). Publication bias will be assessed by Begg test, Egger test and funnel plots. Ethics and dissemination: No primary data will be collected and individual patient information and endangering participant rights, thus ethics approval is not required. Findings will be reported through publication and media. Protocol registration number: PROSPERO CRD42021257981 ( https://www.crd.york.ac.uk/PROSPERO/#joinuppage ).

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Modic Changes (MCs) Associated with Endplate Sclerosis Can Prevent Cage Subsidence in Oblique Lumbar Interbody Fusion (OLIF) Stand-Alone

Cited by 38 publications

References 25 publications

Modic changes - An evidence-based, narrative review on its patho-physiology, clinical significance and role in chronic low back pain

Modic changes - An evidence-based, narrative review on its patho-physiology, clinical significance and role in chronic low back pain

Clinical and radiographic outcomes of hybrid graft in patients with Modic changes undergoing transforaminal lumbar interbody fusion

Prevalence and risk factors for cage subsidence after lumbar interbody fusion

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