Abstract
ObjectiveTo investigate the relationship between Modic changes (MCs) and recurrent lumbar disc herniation (rLDH) and that between the herniated disc component and rLDH following percutaneous endoscopic lumbar discectomy (PELD).MethodsWe included 102 (65 males, 37 females, aged 20–66 years) inpatients who underwent PELD from August 2013 to August 2016. All patients underwent CT and MRI preoperatively. The presence and type of Modic changes were assessed. During surgery, the herniated disc component of each patient was classified into two groups: nucleus pulposus group and hyaline cartilage group. The association of herniated disc component with Modic changes was investigated. The incidence of rLDH was assessed based on a more than 2-year follow-up.ResultsIn total, 11 patients were lost to follow-up; the other 91 were followed up during 24–60 months. Of the 91 patients, 99 discs underwent PELD; 28/99 (28.3%) had MCs. Type I and II MCs were seen in 9 (9.1%) and 19 (19.2%), respectively; no type III MCs were found. Among 28 endplates with MCs, according to the herniated disc component, 18/28 (64.3%) showed evidence of hyaline cartilage in the intraoperative specimens, including 6/9 and 12/19 endplates with type I and II MCs, respectively. Among 71 endplates without MCs, 14/71 (19.7%) showed evidence of hyaline cartilage in the intraoperative specimens. Hyaline cartilage was more common in patients with MCs (P < 0.05). We found 2 cases of rLDH in the non-MC group (n = 71); 6 cases of rLDH were found in the MC group (n = 28), including 2 and 4 cases for types I and II, respectively. There was no significant difference between types I and II (P > 0.05). rLDH was more common in patients with MCs (P < 0.05). We found 5 rLDH cases in the hyaline cartilage group (n = 32); 3 rLDH cases were found in the nucleus pulposus group (n = 67). rLDH was more common in the hyaline cartilage group (P < 0.05).ConclusionsrLDH following PELD preferentially occurs when MCs or herniated cartilage are present.
Highlights
Percutaneous endoscopic lumbar discectomy (PELD), a minimally invasive spinal procedure, has become increasingly well accepted by both surgeons and patients who suffer from lumbar disc herniation (LDH)
Inclusion criteria Patients were included if they had radicular pain for at least 3 months that was refractory to 6 weeks of conservative treatment with or without neurological deficit, numbness in the lumbar spine, buttock, and/or lower extremity, and magnetic resonance imaging (MRI) and computed tomography (CT) demonstrated anatomical LDH correlating with symptoms and no disc calcification
Modic changes (MCs) and Recurrent lumbar disc herniation (rLDH) rLDH was more common in patients with MCs (P < 0.05) (Table 1)
Summary
Percutaneous endoscopic lumbar discectomy (PELD), a minimally invasive spinal procedure, has become increasingly well accepted by both surgeons and patients who suffer from lumbar disc herniation (LDH). There have been many studies designed to determine the recurrence of LDH, and various risk factors were suggested including disc degeneration, trauma, age, smoking, gender, and obesity [3, 4]. Identifiable factors, such as disc degeneration, disc height, and sagittal range of motion have been shown to be related to spinal instability and to rLDH [8,9,10]
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