Modic Endplate Changes Research Articles

Apparent diffusion coefficient maps in the assessment of surgical patients with lumbar spine degeneration.

PurposeTo assess the utility of apparent diffusion coefficient (ADC) maps for the assessment of patients with advanced degenerative lumbar spine disease and describe characteristic features of ADC maps in various degenerative lumbar spinal conditions.MethodsT1-weighted, T2-weighted and diffusion weighted (DWI) MR images of 100 consecutive patients admitted to the spinal surgery service were assessed. ADC maps were generated from DWI images using Osyrix software. The ADC values and characteristic ADC maps were assessed in the regions of interest over the different pathological entities of the lumbar spine.ResultsThe study included 452 lumbar vertebral segments available for analysis of ADCs. Characteristic ADC map features were identified for protrusion, extrusion and sequester types of lumbar disk herniations, spondylolisthesis, reactive Modic endplate changes, Pfirrmann grades of IVD degeneration, and compromised spinal nerves. Compromised nerve roots had significantly higher mean ADC values than adjacent (p < 0.001), contralateral (p < 0.001) or adjacent contralateral (p < 0.001) nerve roots. Compared to the normal bone marrow, Modic I changes showed higher ADC values (p = 0.01) and Modic 2 changes showed lower ADC values (p = 0.02) respectively. ADC values correlated with the Pfirrmann grading, however differed from herniated and non-herniated disks of the matched Pfirrmann 3 and 4 grades.ConclusionQuantitative and qualitative evaluation of ADC mapping may provide additional useful information regarding the fluid dynamics of the degenerated spine and may complement standard MRI imaging protocol for the comprehensive assessment of surgical patients with lumbar spine pathology. ADC maps were advantageous in differentiating reactive bone marrow changes, and more precise assessment of the disk degeneration state. ADC mapping of compressed nerve roots showed promise but requires further investigation on a larger cohort of patients.

Using Natural Language Processing of Free-Text Radiology Reports to Identify Type 1 Modic Endplate Changes

Electronic medical record (EMR) systems provide easy access to radiology reports and offer great potential to support quality improvement efforts and clinical research. Harnessing the full potential of the EMR requires scalable approaches such as natural language processing (NLP) to convert text into variables used for evaluation or analysis. Our goal was to determine the feasibility of using NLP to identify patients with Type 1 Modic endplate changes using clinical reports of magnetic resonance (MR) imaging examinations of the spine. Identifying patients with Type 1 Modic change who may be eligible for clinical trials is important as these findings may be important targets for intervention. Four annotators identified all reports that contained Type 1 Modic change, using N=458 randomly selected lumbar spine MR reports. We then implemented a rule-based NLP algorithm in Java using regular expressions. The prevalence of Type 1 Modic change in the annotated dataset was 10%. Results were recall (sensitivity) 35/50=0.70 (95% confidence interval (C.I.) 0.52-0.82), specificity 404/408=0.99 (0.97-1.0), precision (positive predictive value) 35/39=0.90 (0.75-0.97), negative predictive value 404/419=0.96 (0.94-0.98), and F1-score 0.79 (0.43-1.0). Our evaluation shows the efficacy of rule-based NLP approach for identifying patients with Type 1 Modic change if the emphasis is on identifying only relevant cases with low concern regarding false negatives. As expected, our results show that specificity is higher than recall. This is due to the inherent difficulty of eliciting all possible keywords given the enormous variability of lumbar spine reporting, which decreases recall, while availability of good negation algorithms improves specificity.

Factors that influence recurrent lumbar disc herniation.

The most common cause of poor outcome following lumbar disc surgery is recurrent herniation. Recurrence has been noted in 5% to 15% of patients with surgically treated primary lumbar disc herniation. There have been many studies designed to determine the risk factors for recurrent lumbar disc herniation. In this study, we retrospectively analysed the influence of disc degeneration, endplate changes, surgical technique, and patient's clinical characteristics on recurrent lumbar disc herniation. Patients who underwent primary single-level L4-L5 lumbar discectomy and who were reoperated on for recurrent L4-L5 disc herniation were retrospectively reviewed. All these operations were performed between August 2004 and September 2009 at the Neurosurgery Department of Ataturk Education and Research Hospital in Ankara, Turkey. During the study period, 126 patients were reviewed, with 101 patients underwent primary single-level L4-L5 lumbar discectomy and 25 patients were reoperated on for recurrent L4-L5 disc herniation. Preoperative higher intervertebral disc height (P<0.001) and higher body mass index (P=0.042) might be risk factors for recurrence. Modic endplate changes were statistically significantly greater in the recurrent group than in the non-recurrent group (P=0.032). Our study suggests that patients who had recurrent lumbar disc herniation had preoperative higher disc height and higher body mass index. Modic endplate changes had a higher tendency for recurrence of lumbar disc herniation. Well-planned and well-conducted large-scale prospective cohort studies are needed to confirm this and enable convenient treatment modalities to prevent recurrent disc pathology.

Pattern of lumbosacral magnetic resonance imaging findings in diagnosed cases of disc degenerative disease among Nigerian adults with low back pain

Background: Lumbar spine disc degenerative disease (DDD) has been proven to be the most common cause of low back pain which causes musculoskeletal disability. Magnetic resonance imaging (MRI) allows detailed evaluation of all components of the lumbar spine and assesses abnormalities that may be associated with disc degeneration. Objective: To document the frequency of lumbosacral MRI findings in DDD with correlation to age, gender, and lumbar disc level. Methodology: Two hundred and eighty-one out of three hundred archived magnetic resonance images of patients aged 18 years and above investigated for low back pain at Memfys Hospital for Neurosurgery were enrolled into the study. Axial and sagittal magnetic resonance images were acquired at 5 mm slice thickness with 1 mm gap using spin echo pulse sequence. Results: The mean age of the study population was 55.11 years with a range of 18-91 years. Highest frequency of disc degenerative changes fell within 50-59 years age group and L4/L5 level with male preponderance. Positive findings were disc bulge 51.2%, disc protrusion 87.5%, disc extrusion 19.6%, disc sequestration 1.78%, Modic endplate changes 47.4%, Modic I 10.7%, Modic II 15.3%, and Modic III 21.4%. Logistic regression analysis showed that only posterior disc protrusion and disc bulge were significant. Odd ratio 0.062 and 0.015, respectively, while the beta values are −4.190 and −2.780, respectively. Conclusion: The most common lumbosacral MRI findings in diagnosed cases of DDD among patients with low back pain in this study were posterior disc protrusion, posterior disc bulge, and endplate changes.

The ‘Lumbar Fusion Outcome Score’ (LUFOS): a new practical and surgically oriented grading system for preoperative prediction of surgical outcomes after lumbar spinal fusion in patients with degenerative disc disease and refractory chronic axial low back pain

In order to evaluate the predictive effect of non-invasive preoperative imaging methods on surgical outcomes of lumbar fusionfor patients with degenerative disc disease (DDD) and refractory chronic axiallow back pain (LBP), the authors conducted a retrospective review of 45 patients with DDD and refractory LBP submitted to anterior lumbar interbody fusion (ALIF) at a single center from 2007 to 2010. Surgical outcomes -as measured by Visual Analog Scale (VAS/back pain) and Oswestry Disability Index (ODI)- were evaluated pre-operatively and at 6weeks, 3 months, 6months, and 1year post-operatively. Linear mixed-effects models were generated in order to identify possible preoperative imaging characteristics (includingbone scan/99mTc scintigraphyincreased endplate uptake, Modic endplate changes, and disc degeneration graded according to Pfirrmann classification)which may be predictive of long-term surgical outcomes . After controlling for confounders, a combined score, the Lumbar Fusion Outcome Score (LUFOS), was developed. The LUFOS grading system was able to stratify patients in two general groups (Non-surgical: LUFOS 0 and 1; Surgical: LUFOS 2 and 3) that presented significantly different surgical outcomes in terms of estimated marginal means of VAS/back pain (p = 0.001) and ODI (p = 0.006) beginning at 3months and continuing up to 1year of follow-up. In conclusion, LUFOS has been devised as anew practical and surgically oriented grading system based on simple keyparameters from non-invasive preoperative imaging exams (magnetic resonance imaging/MRI and bone scan/99mTc scintigraphy) which has been shown to be highly predictive of surgical outcomes of patients undergoing lumbar fusion for treatment for refractory chronic axialLBP.

Frequency of Vertebral Endplate Modic Changes in Patients with Unstable Lumbar Spine and Its Effect on Surgical Outcome.

Study DesignProspective cohort study.PurposeIn this study, we investigated the frequency of vertebral endplate Modic changes (MCs) and their effects on surgical outcomes in patients with unstable lumbar spines.Overview of LiteratureSignal changes in endplates have been classified into three types by Modic. The prognostic role of MCs has been investigated in various spinal disorders.MethodsA series of 70 patients with clinical and radiographic unstable lumbar spine were included in the study. Endplate signal intensity was determined according to Modic classification. All patients underwent instrumented posterolateral fusion. Functional evaluation was made using the visual analog scale (VAS) and Oswestry disability index (ODI).ResultsEighteen patients (26%) had normal endplate intensity, 31 patients (44%) had MC type I, 20 patients (28%) had MC type II, and one patient (1.4%) had MC type III. Pain level VAS and ODI decreased significantly from the preoperative evaluation to the six-month and one-year postoperative evaluations. The surgical outcome (VAS and ODI) was not significantly different between the various types of MC.ConclusionsPosterolateral fusion is an effective treatment in patients with unstable lumbar spines. MC do not have a significant effect on the surgical outcome of these patients.

Effects of sagittal endplate shape on lumbar segmental mobility as evaluated by kinetic magnetic resonance imaging.

Retrospective analysis using kinetic magnetic resonance imaging. To investigate relationships between vertebral endplate remodeling, Modic changes, disc degeneration, and lumbar segmental mobility. Previous studies have shown that disc degeneration and vertebral endplate Modic changes are associated with differences in spinal motion, however, the effects of vertebral endplate morphology on lumbar segmental motion have not been fully investigated. A total of 420 patients underwent kinetic magnetic resonance imaging of 2100 lumbar motion segments. Sagittal endplate shapes (concave, flat, irregular), Modic changes (types, 0-3), and disc degeneration (grade, I-V) were assessed along with translational and angular motion of vertebral segments in flexion, extension, and neutral positions. The most common findings were concave endplate shape (63.24%), type 2 Modic change (71.79%), and grade II disc degeneration (40.33%). Flat, irregular endplates were more common at L1-L2, L4-L5, and L5-S1 than L2-L3 and L3-L4. Types 1, 2, and 3 Modic changes increased in frequency according to endplate shape: concave less than flat less than irregular. Type 0 was observed to decrease with the change of endplate shape from flat to concave to irregular. Vertebral levels with irregular endplates had more disc generation than those with flat; levels with flat endplates had significantly more disc degeneration than those with concave. Translational motion of the lumbar segment was greatest at levels with irregular endplates and decreased at those with flat and then concaves endplates. Angular motion was least at levels with irregular endplates and increased at levels with flat, then concave endplates. The degree of pathogenic lumbar segmental motion is associated with remodeling of the sagittal endplate. Endplate remodeling may occur as an adaptation to restrain abnormal movement of the lumbar segment. N/A.

Operative Management of Lumbar Disc Herniation with End Plate Modic Changes Necessitates More Definite Procedures

Introduction Nucleotomy through interlaminar fenestration has been the standard operation for lumbar disc herniation, but it does not always work well in clinical practice. End plate Modic changes are strongly linked with lower back pain, and Modic changes in the end plates of the herniation level may be one reason for the unpredictable result of nucleotomy alone. Studies on more definite surgical procedures for lumbar disc herniation with end plate Modic changes are still rare. To compare the clinical outcomes between two surgical options, nucleotomy alone and nucleotomy with additional posterolateral lumbar interbody fusion (PLIF), for lumbar disc herniation patients with end plate Modic changes, and to testify the hypothesis that end plate Modic change is an indication of interbody fusion for operative management of lumbar disc herniation. Materials and Methods A total of 91 patients who complained about both lower extremity radicular pain and lower back pain (lower back pain more severe than leg pain) were included, and all of them were of single segment disc herniation with Modic changes in the corresponding lumbar degenerative end plates. Of the 91 patients, 47 were treated with nucleotomy alone and 44 were treated with posterolateral lumbar interbody fusion (PLIF) in addition to nucleotomy. They were followed up for at least 2 years. Clinical outcomes were evaluated according to the Japanese Orthopaedic Association (JOA) score and visual analogue scale (VAS) for lower back pain and VAS for lower extremity radicular pain before operation and at each follow-up, and the results before surgery and at 18 months after operation were statistically compared. Results In both the groups, the JOA scores, as well as VAS, for lower back pain significantly improved 18 months after surgery. The improvement rate of JOA score and power of improvement of VAS for lower back pain also showed significant difference between the two groups, being better in nucleotomy with PLIF procedure than in nucleotomy alone procedure. On the contrary, the mean VAS of lower extremity radicular pain showed a significant reduction in both groups at the follow-up of 18 months after operation. However, a significant difference of the power of this improvement between both the groups was not found. Conclusion Operative management of lumbar disc herniation with end plate Modic changes necessitates more definite procedures in addition to nucleotomy. PLIF is a good and reliable option. Disclosure of Interest None declared

Prevalence of Vertebral Endplate Modic Changes in Degenerative Lumbar Scoliosis and Its Associated Factors Analysis

A retrospective study of modic changes (MCs) in degenerative lumbar scoliosis (DLS). To investigate the prevalence of vertebral endplate MCs in DLS and explore their associated factors. MCs are common in spinal degenerative diseases. Presently, most of the researches have been focused on investigating the relationship between MCs and chronic low back pain. Little has been known on the distribution of MCs in DLS and the relationship between MCs and scoliosis. The image data of 120 patients who had been diagnosed with DLS in our hospital from March 2005 to March, 2011 were retrospectively reviewed as the study group. The image data of 89 patients who had been diagnosed with degenerative lumbar diseases without scoliosis were selected as the control group. The prevalence, type, and distribution of MCs in 2 groups were observed and compared. Disc degeneration, Cobb angle, body weight, and smoking were recorded in the study group, and the relationship of MCs with these influential factors was analyzed. Of 1440 endplates from 120 patients in the study group, 247 (17.2%) from 71 (59.2%) patients were found to have MCs. Compared with the control group, of 1068 endplates from 89 patients, 49 (4.5%) endplates from 21 (23.6%) patients were found to have MCs. The prevalence of MCs was significantly higher in the study group than that in the control group (P < 0.01). The MCs in DLS usually had asymmetric distribution with more frequent occurrence on the concave side than on the convex side of major or compensatory curve and mainly occurred at L2-L3, L4-L5, and L5-S1, which were in accordance with the common levels of apex vertebrae. Intervertebral disc degeneration, lumbar scoliosis, overweight and heavy smoking are considered as risk factors to MCs. By multinomial logistic regression analysis on these factors, the regression function was obtained: logit Y = -0.82 + 1.27D + 0.55S + 1.77 D × S (Y for MCs, D for intervertebral disc degeneration, S for scoliosis Cobb's angle and D × S for interaction of D and S). The prevalence of MCs in patients with DLS was significantly higher than that of patients without DLS. Most of them were type 2 and usually located on the concave side of apex vertebrae. MCs were significantly associated with intervertebral disc degeneration and lumbar scoliosis.

Reviewer’s comment concerning “The influence of preoperative MRI findings on lumbar fusion clinical outcomes” (doi:10.1007/s00586-012-2244-9 Mladen Djurasovic, Leah Y. Carreon, Charles H. Crawford III, Jason Zook, Kelly Bratcher, Steven D. Glassman)

The authors of this study address the important question, whether any of the well-known and accepted MRI parameters has a predictive value in regard to outcome. In our daily clinical routine indication for surgery and the expected outcome are to a considerable degree based on the MRI findings in a particular patient. Therefore, the results of this study are of value. The authors included 51 patients with 71 treated disc levels to investigate which of the well-known disc changes [disc desiccation, disc contour, presence of a high-intensity zone (HIZ) annular tear, presence of Modic endplate changes, disc height] has an influence on the 2-year outcome after lumbar fusion. Disc height was the only parameter correlated to outcome, with disc heights less than 5 mm showing the best improvement in the various outcome scores. This result is not surprising since most spine surgeons would agree that advanced degenerative disc changes, if causative, benefit from fusion. On the other way round, the fact that patients with large disc height do not improve considerably is more interesting. This finding argues in favour of the non-fusion strategies currently under investigation. In summary, I consider the paper an important approach for a better understanding of indications and outcome after lumbar fusion. However, due to the retrospective study design, the mixture of patients and the integration of patients fused at multiple levels, the results have to be interpreted with caution. Further studies focusing on well-defined patient groups need to be conducted.

The influence of preoperative MRI findings on lumbar fusion clinical outcomes

Spinal fusion as a treatment for degenerative disc disease is controversial. Prior authors have identified various MRI findings as being pain generators, which might help guide patient selection for lumbar fusion procedures. These findings have included disc desiccation, disc contour, high-intensity zone annular disruption, the presence of Modic endplate changes, and disc space collapse. The purpose of this study is to investigate which MRI findings in patients with degenerative disc disease predict clinical improvement with lumbar fusion. A single-center surgical database of patients undergoing lumbar fusion was reviewed for patients whose indication for fusion surgery was primary disc pathology. We identified 51 patients (71 disc levels) who had completed 2-year prospectively collected outcomes questionnaires and had preoperative MRIs available for review. NRS (0-10) back and leg pain, Oswestry Disability Index (ODI) and SF-36 Physical Composite Summary scores were obtained preoperatively and at 1- and 2-year follow-up. MRIs were reviewed by three fellowship-trained spine surgeons who were asked to grade them for the following five characteristics: (a) disc desiccation, (b) disc contour, (c) presence of a high-intensity zone (HIZ) annular tear, (d) presence of Modic endplate changes and (e) disc height. Two-year outcome measures were compared to MRI findings to identify which findings correlated with improvement in outcome scores. Statistically significant improvements were noted in back pain, leg pain, SF-36 PCS and ODI in the group overall. Disc desiccation, disc contour, presence of an HIZ lesion, and the presence of Modic endplate changes did not correlate with 2-year outcomes. Disc height was correlated with 2-year change in outcome measures. Discs with preoperative height less than 5 mm demonstrated a 23.4 point ODI improvement compared to 9.2 points for discs >7 mm. Similarly, SF-36 PCS improved 9.5 points in discs <5 mm compared to 0.7 in discs greater than 7 mm. Discs between 5 and 7 mm demonstrated intermediate levels of improvement. Several commonly utilized MRI criteria proposed as indications for lumbar fusion do not seem to correlate with 2-year improvement in clinical outcomes. Discs which are narrowed and collapsed, preoperatively, demonstrate better improvement at 2 years postoperatively as compared to discs which have maintained disc height. Significant disc space collapse may represent a subset of "degenerative disc disease" which responds more favorably to treatment with fusion.

Intradiscal injection therapy for degenerative chronic discogenic low back pain with end plate Modic changes

Intradiscal injection therapy for degenerative chronic discogenic low back pain with end plate Modic changes

Clinical Results of Lumbar Total Disc Arthroplasty in Accordance With Modic Signs, With a 2-Year-Minimum Follow-up

Prospective study. The aim of this prospective study is to analyze the influence of Modic type on the clinical results of lumbar total disc arthroplasty. Some patients with lumbar disc degeneration have endplate signal changes on magnetic resonance images, which have been classified by Modic. Modic-1 endplates changes are associated with an inflammatory phase of the disease whereas Modic-2 endplates changes correspond to a quiescent phase with a fatty replacement. The effect of Modic endplate changes on the clinical results of lumbar fusion has been studied by multiple authors, but the influence of Modic type on clinical outcomes of lumbar disc replacement is not known. A total of 221 patients with a mean age of 42 years were included in this study. Of which, 107 patients were classified Modic 0, 65 Modic 1, and 49 Modic 2. Clinical evaluation (Oswestry Disability Index [ODI], lumbar and radicular pain using the Visual Analog Score [VAS]) was performed preoperatively and at 3, 6, 12, and 24 months minimum postoperatively. Mean follow-up was 30 months (24-72 months). Significant clinical improvement (P < 0.05) was observed in pain and ODI between the preoperative evaluation and final follow-up. Multivariate analysis between the 3 groups demonstrated a significant difference in Oswestry Disability Index (size of the effect was measured at -0.3 [-0.55-0.04]) and on the radicular pain (size of the effect was measured at -0.4 [-0.7-0.1]), with lower scores in the group classified Modic 1. Superior results were achieved in the group of patients with Modic-1 endplate changes on magnetic resonance images. These data may be helpful in patient selection and in preoperative patient counseling.

Something is amiss

Commentary on: Cao P, Jiang L, Zhuang C, et al. Intradiscal injection therapy for degenerative chronic discogenic low back pain with end plate Modic changes. Spine J 2011:11:100-106 (in this issue).

Modic changes and intradiscal steroids

Commentary on: Cao P, Jiang L, Zhuang C, et al. Intradiscal injection therapy for degenerative chronic discogenic low back pain with end plate Modic changes. Spine J 2011;11:100-106 (in this issue).

Intradiscal injection therapy for degenerative chronic discogenic low back pain with end plate Modic changes

Background context The effect of intradiscal steroid therapy for patients with degenerative chronic discogenic low back pain remains an issue of debate. Purpose To evaluate the effect of various intradiscal injection regimens for patients with degenerative chronic discogenic low back pain and end plate Modic changes. Study design Double-blind, randomized, controlled, prospective clinical study. Patient sample One hundred twenty patients with discogenic low back pain and end plate Modic changes on magnetic resonance imaging (MRI) who received discography but were unwilling to accept surgical operation. Outcome measures Pain and function were determined by the visual analog scale (VAS) and the Oswestry Disability Index (ODI) assessment. Methods Patients who received diagnostic discography for suspected degenerative discogenic low back pain were recruited. A total of 120 patients with positive discography and end plate Modic changes at a single level were enrolled in the study and allocated into Groups A and B according to the type of Modic changes on MRI. Then, the patients in Groups A and B were randomized into three subgroups, respectively. Intradiscal injection of normal saline was performed in Subgroups A1 and B1, intradiscal injection of diprospan was performed in Subgroups A2 and B2, and intradiscal injection of a mixed solution of diprospan+songmeile (cervus and cucumis polypeptide) was performed in Subgroups A3 and B3. The clinical outcome of each patient was evaluated and recorded by using the VAS and ODI at 3 and 6 months after the procedure. Results The subgroups were comparable with respect to gender, age, pain, and percentage disability. Neither VAS pain scores nor Oswestry function scores of the patients within Group A had any improvement at 3 or 6 months after saline injection, but both of them improved significantly at the two time points after diprospan and diprospan+songmeile injection, respectively. Meanwhile, the latter two injection protocols led to no significant difference in pain relief and functional recovery. Similar results were obtained in patients within Group B. Furthermore, no difference of the improvement of VAS pain scores or Oswestry function scores was found between the patients within Group A and within Group B at different time points after various interventions. Conclusion Intradiscal injection of corticosteroids could be a short-term efficient alternative for discogenic low back pain patients with end plate Modic changes on MRI who were still unwilling to accept surgical operation when conservative treatment failed.

Population-specific Conclusions about Modic Endplate Changes

Population-specific Conclusions about Modic Endplate Changes

Intradiscal interventional therapy for degenerative chronic discogenic low back pain with end-plate Modic changes

To observe the different efficacies of intradiscal interventional therapy for patients with degenerative chronic discogenic low back pain and end-plate Modic changes through different types of injection and to evaluate the potential therapeutic value of intradiscal injection treatment for degenerative chronic discogenic low back pain with different types of end-plate Modic changes by using appropriate injection. Patients with single segmental degenerative chronic discogenic low back pain proved by discography were classified as Modic type I predominant change (including Modic Type I & Modic type I predominant mixed Type I/II) and Modic type II predominant change (including Modic Type II & Modic Type II predominant mixed Type II/I) according to the end-plate Modic changes on MRI. All received the intradiscal injection treatment. Patients were divided into three groups: (1) A group (control group): intradiscal injection of normal saline 3 ml; (2) B group (treatment group): intradiscal injection of diprospan (compound betamethasone) 3 ml; (3) C group (treatment group): interventional injection of diprospan (compound betamethasone) 1 ml + songmeile (cervus & cucumis polypeptide injection) 2 ml. Pain and function were evaluated by pain visual analogue scale (VAS) and Oswestry disability index (ODI). T-test was applied for efficacy comparison in each group at pre-operation, 3 months and 6 months post-operation. Sixty patients were included. There were 39 males and 21 females with a mean age of 41.6 years old (26 - 58). There were 10 patients in each group: A-Modic I, A-Modic II; B-Modic I, B-Modic II; C-Modic I, C-Modic II. There was no significant statistical difference in preoperative VAS and Oswestry scores among groups; VAS and Oswestry scores of B group and C group at 3 months and 6 months post-operation were significantly better than those pre-operative scores, and also better than that of control group (A group) at the same time. But there was no significant difference in scores between 3 months and 6 months in ether B group or C group, and there was also no significant difference in VAS and Oswestry scores between B group and C group at various time points. Various Modic types had no correlation with either VAS score or Oswestry score in each group at various time points. Intradiscal interventional therapy can relieve discogenic low back pain and improve Oswestry disability index score of function between 3 and 6 months post-operation. There is no significant difference in post-operative efficacy between Modic Type I and Modic Type II. Steroids are the major analgesic factor of intradiscal injection. But the synergistic application of songmeile (cervus & cucumis polypeptide injection) can maintain the analgesic effect and duration with a decreased dose of steroids.

Selection of surgical methods for lumbar disc herniation with degenerative endplates changes

To analyze the selection of surgical methods for lumbar disc herniation with low back and leg pain and degenerative lumbar Modic endplate changes and their different postoperative therapeutic effects. All 30 cases of single segment lumbar disc herniation accompanied by Modic endplate changes operated at our hospital using simple discectomy or decompressions with interbody fusion from January 2005 to January 2008 were retrospectively identified. There were 18 males and 12 females with an average age of 38.5 years old (26-53 years old) and an average follow-up of 21 months (4-40 months). Discectomy alone group included 15 cases. The average score of Japanese Orthopedics Association (JOA) and visual analysis scale (VAS) of low back pain and lower extremity radicular pain at the preoperative and final follow-up time was 13.2 (5-17), 6.8 (4-10), 4.8 (1-8) and 19.8 (14 -24), 4.8 (2-10), 1.2 (0-6) respectively. The average improvement rate of JOA was 41.9%. The difference of VAS of lower extremity radicular pain between pre and post-operation was 3.7 on average. Among these 15 cases, Modic I, II and I/II mixed-type was 5, 9, and 1 respectively. Decompression with interbody fusion group included 15 cases. VAS of low back pain and lower extremity radicular pain at the preoperative and final follow-up time was 12.9 (5-17), 7.0 (4-10), 4.9 (1-8) and 22.6 (19-28), 2.8 (2-8) and 1.3 (0-6) respectively. The average improvement rate of JOA was 63.4%. The differences of VAS of lower extremity radicular pain and low back pain between pre and post-operation were 4.3 and 3.6 on average respectively. Among these cases, Modic I, II and I/II mixed-type was 6, 8, and 1 respectively. Comparing the VAS of low back pain, JOA average score and the improvement rate of JOA score of two groups at pre-operation and post-operation, statistical analysis showed that decompression with interbody fusion group was superior to simple discectomy group. For lumbar disc herniation with degenerative Modic endplate changes, who suffered more from low back pain than lower extremity radicular pain, discectomy alone and decompression with interbody fusion could both improve the degree of lower extremity radicular pain, but discectomy alone is less likely to improve the degree of low back pain and function score than the latter. So the maneuver of lumbar decompression with fusion is a better choice.

MRI follow-up of subchondral signal abnormalities in a selected group of chronic low back pain patients

MRI follow-up of subchondral signal abnormalities in a selected group of chronic low back pain patients