Abstract
PurposeFew retrospective studies have addressed Modic changes (MC) following lumbar spine surgery, though it is usually assumed that MC increase in grade and incidence. To test this conventional wisdom, we investigated the natural course of MC following primary lumbar limited discectomy with two-year follow-up. In addition, a possible clinical relevance to those changes was assessed.MethodsThe data of the control group (278 subjects) of a prospective randomized, controlled trial (RCT) were evaluated retrospectively.ResultsWe did not observe a simple increase in MC with regard to grade. There is variable activity observed in Type 2 (at 12 months) and in Type 1 (at 24 months). Conversion from one grade to another may occur and may be upward or downward. The incidence of MC increased slightly over time, as after surgery a decreasing percentage of the study group remained without MC over two years (1 year: 34% (85/250); 2 years: 30% (72/237)). Radiological parameters (rotation, translation, and spondylolisthesis) had no significant correlation to MC or MC subtypes. Lastly, we found that neither the different MC types nor their changes were correlated with clinical parameters (VAS back, VAS leg, ODI score) preoperatively or during follow-up.ConclusionThe pattern of Modic changes following lumbar limited discectomy is complex, not simply increasing. There is variable activity in MC Types 1 and 2 at the different time points of follow-up, and conversion from a higher grader to a lower one or vice versa is possible.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.
Highlights
Since the first description and classification of signal abnormalities of the vertebral endplate and subchondral bone marrow oedema in magnetic resonance tomography (MRI) of the lumbar spine, the interpretation and clinical correlation has been the subject of debate [1, 2]
To proof the common sense we investigated the natural course of Modic changes following primary lumbar limited with two year follow up prospectively
There was a different pattern of transformation over time when analysing the Modic changes (MC) Types and subtypes (Table 4)
Summary
Since the first description and classification of signal abnormalities of the vertebral endplate and subchondral bone marrow oedema in magnetic resonance tomography (MRI) of the lumbar spine, the interpretation and clinical correlation has been the subject of debate [1, 2]. The disc is chronically exposed to forces and stresses This may lead accumulatively to damage, which can cause bone marrow oedema [6] or microfractures [7]. To date there is no study available to evaluate the natural course of MC after a limited lumbar discectomy in a cohort of patients with prospectively collected data with a two-year follow-up and multiple imaging. This would allow real insight into these dynamic vertebral endplate changes, including any possible clinical relevance
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