What happens to Modic changes following lumbar discectomy? Analysis of a cohort of 41 patients with a 3- to 5-year follow-up period

Abstract

Object. The natural history of Modic changes (MCs) in the lumbar spine is often marked by conversion from one type to another, but their course following lumbar discectomy remains unknown. The authors sought to study the impact of surgery on the natural history of these lesions.Methods. Forty-one patients treated with lumbar microdiscectomy between 2004 and 2005 were enrolled in this study and underwent clinical evaluation and repeat MR imaging after a median follow-up of 41 months (range 32-59 months). Preoperative and follow-up MR images were reviewed and the type, location, and extent of MCs at the operated level were recorded and compared.Results. The study population consisted of 27 men and 14 women with a mean age of 54 years (range 24-78 years). During the follow-up period, the prevalence of MCs increased from 46.3% to 78%, and 26 patients (63.4%) had Type 2 lesions at the operated level. Of the 22 patients without MCs, 4 (18.2%) converted to Type 1 and 9 (40.9%) to Type 2. Of the 5 Type 1 lesions, 3 (60%) converted to Type 2, and 2 (40%) remained Type 1 but increased in size. In contrast, none of the 14 Type 2 changes converted to another type, although 10 (71.4%) increased in extent. There were no reverse conversions to Type 0.

The course of Modic vertebral body changes after posterolateral lumbar fusion on fused and adjacent levels: A systematic review of the literature

“…After lumbar discectomy, however, no regression was documented, but there was an increase in the prevalence of Modic changes from 46% to 78% after a mean follow-up of 41 months, mostly from type 0 and type I conversions [12]. The rate of type II changes was extremely prevalent at the operated level (63.4%) as a potential consequence of the accelerated disc degeneration [12].…”

Factors that influence recurrent lumbar disc herniation

“…Studies of Modic endplate changes after lumbar discectomy have shown incremental changes in disc degeneration grade. 18,26 It is accepted that Modic type 1 changes are dynamically unstable and inflammatory lesions, whereas type 2 lesions are much more stable and unchangeable. 26 Therefore, posterior lumbar interbody fusion combined with pedicle screw fixation is suggested for degenerative lumbar disc disease with Modic changes.…”

“…18,26 It is accepted that Modic type 1 changes are dynamically unstable and inflammatory lesions, whereas type 2 lesions are much more stable and unchangeable. 26 Therefore, posterior lumbar interbody fusion combined with pedicle screw fixation is suggested for degenerative lumbar disc disease with Modic changes. 27 Another study suggested treatment of Modic type 1 and 2 lesions with degenerative disc disease with posterior dynamic stabilisation.…”

Prevalence of Modic Changes in Active Duty Military Men With Lumbar Disk Herniation Who Were Scheduled for Surgery

“…7 In earlier studies, MC has been described as a dynamic process that is related to herniated disks in the lumbar spine. 5,14 Disk herniation demonstrated to be a strong risk factor on the development of MC (especially MC type I). 13 Rahme et al 14 studied 41 patients who underwent lumbar discectomy and reported MC type II to be most commonly seen at the operated level.…”

“…13 In a study of 41 patients scheduled for surgical treatment, the prevalence of MC was 46.3%, similar with predominance of MC type II. 14 Overall, the influence of many determinants on MC remains unclear due to limited research because of the complexity of patient factors (eg, age, sex, surgical intervention and level of physical activity) and the different properties involved with MC (eg, types, levels in the lumbar spine and the dynamic processes). Therefore, the purpose of this observational study was to evaluate the presence of preoperative MC on MRI before designing clinical studies concerning the course of MC in relation to herniated disks and to identify MC in patients with a lower lumbar disk herniation who were scheduled for surgery (lumbar discectomy) in a relatively young and homogeneous population of men in the military with a high physical workload.…”