Retrospective and comparative analysis of therapy for degenerative chronic discogenic low back pain with end plate Modic changes with discography and intradiscal injection blockage

Abstract

To evaluate the prognosticating effects of discography and intradiscal injection blockage for patients with degenerative chronic discogenic low back pain and end plate Modic changes when posterior lumbar interbody fusion (PLIF) was adopted. Patients who received diagnostic discography for suspected degenerative discogenic low back pain were recruited. A total of 60 patients (42 males and 18 females) with positive discography and end plate Modic changes at a single level were enrolled in the study and allocated into Groups A and B: Group A was both positive sign of discography and negative sign of intradiscal injection blockage two weeks later, which further was subdivided into Group A1 (Modic I endplate change) and Group A2 (Modic II endplate change). Group B was both positive sign of discography and intradiscal injection blockage two weeks later, which further was subdivided into Group A1 (Modic I endplate change) and Group A2 (Modic II endplate change). There were 15 cases in each subgroup, with a mean age of 43.2 years old (29 to 62 years old). The lumbar decompression combined with interbody fusion was performed for these patients. The clinical outcome of each patient was evaluated and recorded by using the VAS and ODI before operation and at 24 months after the procedure. The bone fusion state was evaluated by both dynamic X-ray and CT reconstruction films. There was no statistical difference of the scales of VAS and ODI before operation.Compared with the scales before operation, although the scales of VAS and ODI of both group A and group B at 24 months after the procedure were significantly improved, the scales of both VAS and ODI of group B were significantly superior to group A. The statistics analysis showed that comparing the improvement rate of VAS and ODI before and after operation, group B was significantly superior to group A, but there was no obviously correlations between the type of Modic endplate change and the the improvement rate of VAS and ODI. The combination the discography with intradiscal injection blockage before operation would effectively prognosticate the therapy of posterior lumbar interbody fusion. There was no obviously correlations between the type of Modic endplate change and the improvement rate of VAS and ODI.