Predictive value of magnetic resonance imaging in lumbosacral fusion decision making. A case report

Abstract

Study design: A case report of a L4-5 Modic I discopathy and its post operative clinical and MRI outcome emphazise importance of adjacent disc pre operative assessement.Objective: To assess the need of a correct strategy in lumbosacral fusion decision making.Summary and background data: Modic classification is well known but evolution and relations between the three different stages is not well documented.Methods: A L4-5 fusion performed with Titanium instrumentation enables to document a Modic I stage becoming Modic II after successfull fusion. In the mean time the upper adjacent disc L3-4 Modic III deteriorated in Modic I. A new fusion L3-Sacrum enabled to document the same outcome L3-4 Modic I becoming after successfull fusion Modic II.Result: this specific case demonstrates twice the efficiency of postero lateral fusion in the treatment of discopathy. Modic II stage assessing local stability correlated in our case to good clinical evolution. It also demonstrates the risk of adjacent disc failure in case of Modic I image.Conclusion: M.R.I. pre operative finding needs to be taken in account in fusion decision making. Discopathy can be cured by successful postero lateral fusion. Thus anterior intervertebral fusion or postero lumbar interbody fusion is not mandatory as demonstrated twice in this specific case. Levels of fusion needs correct assessement and can explain poor results.