Abstract
BackgroundThis 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.MethodsClinical 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.ResultsThere 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.ConclusionIn 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.
Highlights
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
Repeatedmeasures analysis was used for C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels and Student−Newman−Keuls test was used for group-togroup comparisons
There were no significant differences between the 3 groups with respect to preoperative demographic factors, including age (P = 0.216), sex (P = 0.903), body mass index (BMI) (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 duration of follow-up (P = 0.372) (Table 1)
Summary
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. Transforaminal lumbar interbody fusion (TLIF) is a widely used procedure for treatment of degenerative lumbar spine disease. Implantation of an intervertebral cage and autologous bone graft help restore the intervertebral height and promote fusion [1,2,3]. Bone graft material is one of the main determinants of intervertebral fusion. The common sources of bone graft used for TLIF include autologous iliac graft, autologous local bone graft, and allograft. Each bone graft material has its advantages and disadvantages. The use of autologous iliac graft or local bone graft is associated with reasonable fusion rate and does not entail the risk of rejection; availability of a limited amount of bone graft and increase in the postoperative recovery time are disadvantages. The use of allograft does not entail the problems of limited autologous bone supply and invasive bone retrieval. The treatment cost is typically high, and allografts are prone to rejection, osteolysis, and resorption [4,5,6]
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