The Modic Vertebral Endplate and Marrow Changes: Pathologic Significance and Relation to Low Back Pain and Segmental Instability of the Lumbar Spine

Rahme, Ralph; Moussa, Ronald

doi:10.3174/ajnr.a0925

Cited by 221 publications

(172 citation statements)

References 38 publications

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“…Although their presence has often been associated with LBP and SI 13,17,18 , neither the presence nor the type of preoperative Modic changes had any impact on the clinical and functional outcomes in this series. Our finding is similar to that of Chin et al 34 who documented similarly satisfactory results following LMD in both patients with and without preoperative Modic changes.…”

Section: Radiological Findingsmentioning

confidence: 87%

“…Given the lack of consensus on a radiological definition of instability 18,22 , dynamic flexion-extension radiographs were not performed. Instead, we relied on clinical criteria of SI which may better correlate with patient outcome after LMD 7,8,10 .…”

Section: Methodsmentioning

confidence: 99%

“…dynamic flexion-extension radiographs, in this study. Although classically a radiological concept, segmental instability of the lumbar spine still lacks a consensual radiographic definition 18,22 . Moreover, there is very limited correlation between radiological intervertebral motion and patient symptoms 22 .…”

Section: Presence Of Symptomsmentioning

confidence: 99%

“…Our finding is similar to that of Chin et al 34 who documented similarly satisfactory results following LMD in both patients with and without preoperative Modic changes. It would have been interesting to separately analyze the subgroup of patients with type 1 Modic changes as these are often considered to be markers of biomechanical instability 17,18 . Unfortunately however, such a subgroup analysis was not possible given the small number of patients with Modic 1 changes in this series.…”

Section: Radiological Findingsmentioning

confidence: 99%

“…of underlying active degeneration and instability 17,18 , but it is still unclear whether their presence affects patient outcome after LMD.…”

mentioning

confidence: 99%

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Lumbar Microdiscectomy: A Clinicoradiological Analysis of Outcome

Rahme

Moussa

Bou-Nassif

et al. 2011

Can. J. Neurol. Sci.

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While short-term results of lumbar microdiscectomy (LMD) are favorable in over 85% of cases, long-term outcome is often less rewarding and tends to be similar to that of nonoperative management of lumbar disc herniation (LDH), with only 55-70% favorable results [1][2][3][4][5][6] . Low back pain (LBP) is the usual cause for the drop in patient satisfaction and has been linked to the development of post-operative segmental instability (SI) 1,[6][7][8][9][10][11][12][13] .However, whether instability is a direct consequence of surgery or whether it is part of the natural history of lumbar degenerative disc disease (DDD) is still a matter of debate 6,14,15 . Some authors have suggested that post-operative disc space collapse (DSC) of more than 25-30% after aggressive ABSTRACT: Background: The long-term outcome after lumbar microdiscectomy (LMD) may be affected by low back pain (LBP) and segmental instability, the determinants of which remain unclear. We sought to analyze the interaction between clinical, functional, and radiological variables and their impact on patient outcome. Methods: All patients who underwent LMD in 2004-2005 were invited to participate in this retrospective cohort study. Patients were re-evaluated clinically and radiologically after a three to five year follow-up. Results: Forty-one of 97 eligible patients were enrolled. Twelve patients (29.3%) reported moderate-to-severe sciatica, 12 (29.3%) had moderate LBP, and 13 (31.7%) exhibited clinical evidence of segmental instability. Thirty-eight patients (92.7%) had minimal disability and 3 (7.3%) had moderate disability. Twenty-three patients (56.1%) were fully satisfied, while 18 (43.9%) had only partial satisfaction, having expected a better outcome. Thirty-three patients (80.5%) returned to full-time work. Median disc space collapse (DSC) was 20% (range 5-66%) and L4-L5 was particularly affected. Prevalence of Modic changes increased from 46.3% to 78% with type 2 predominance. Multivariate logistic regression analysis identified the following negative prognostic factors: female sex, young age, lack of regular exercise, and chronic preoperative LBP. There was no correlation between the course of Modic changes, DSC, and patient outcome. Conclusion: Although many patients may be symptomatic following LMD, significant disability and dissatisfaction are uncommon. Female sex, young age, lack of exercise, and chronic preoperative LBP may predict a worse outcome. Disc collapse is a universal finding, particularly at L4-L5. Neither DSC nor Modic changes seem to affect patient outcome.RÉSUMÉ: Analyse clinico-radiologique des résultats de la microdiscectomie lombaire. Contexte : Le résultat à long terme de la microdiscectomie lombaire (MDL) peut être influencé par la douleur lombaire (DL) et l'instabilité segmentaire dont les facteurs déterminants sont mal connus. Le but de notre étude était d'analyser l'interaction entre des variables cliniques, fonctionnelles et radiologiques ainsi que leur impact sur le résultat chez le patient. Méthode : Tous les pat...

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Section: Radiological Findingsmentioning

confidence: 87%