A new surgical strategy for the intractable chronic low back pain due to type 1 Modic change using transforaminal full-endoscopic disc cleaning (FEDC) surgery under the local anesthesia : A case report and literature review

Abstract

It has been reported that Modic change of the lumbar spine endplate includes three types: i.e. . edema or inflammation for type 1, fatty marrow change for type 2 and sclerotic change for type 3. Basically, type 1 Modic change may be related to the chronic low back pain. There are two kinds of the treatment for the type 1 Modic change to heal the pain : the anti-inflammatory drugs, and intra-discal injection of steroid. When the inflammatory change would be intractable, surgical intervention is needed. The gold standard for the surgical intervention is the segmental fusion of the affected level. The fusion surgery may cause the adjacent degeneration ; thus, motion preservation surgery is better, if possible. Our department started the motion preservation full-endoscopic intradiscal debridement surgery for this pathology, since some of the type 1 Modic change may be chronic discitis by P. Acnes. In this paper, we describe the first patient of type 1 Modic change who was successfully treated by the full-endoscopic intra-discal debridement and drainage under the local anesthesia. We named this procedure as transforaminal full-endoscopic disc cleaning surgery (FEDC). Finally, pathology, conservative and surgical intervention of Modic change was discussed.

Autologous Platelet-Rich Plasma Administration on the Intervertebral Disc in Low Back Pain Patients with Modic Type 1 Change: Report of Two Cases

“…The Modic type 1 treatment is still controversial with some reports showing that antimicrobial agents are effective [ 18 ], whereas others reported that they were ineffective [ 19 ]. Sairyo et al reported a patient with Modic type 1 who was successfully treated with endoscopic surgery, flushing, and drainage [ 20 ]. As Modic type 1 has various etiological factors, it may be necessary to develop a treatment plan for each case.…”

Full-endoscopic Spine Surgery for Discogenic Low Back Pain with High-intensity Zones and Modic Type 1 Change in a Professional Baseball Player

“…Sairyo et al 17) have recently published a report on FEDC surgery for Modic type 1 change. Suspecting an association between Propionibacterium acnes bacteria and intradiscal infection in a patient with Modic type 1 change, they performed intradiscal debridement and cleaning using a full-endoscopic technique with a water irrigation system.…”

“…The diagnosis was lumbar discogenic low back pain with HIZ and Modic type 1 change at L4/5 and L5/S1. We planned FED with TA and FEDC 17) at L4/5 and L5/S1 during the baseball off-season.…”

Vertebrogenic Pain: A Paradigm Shift in Diagnosis and Treatment of Axial Low Back Pain

“…Other than intraosseous BVN RFA, vertebrogenic pain has been treated with extraosseous epiduroscopic BVN/SVN laser ablation or bipolar RFA [ 77–79 ], intraosseous plasma rich growth factor [ 80 ], intraosseous injection of bioresorbable cement [ 81 ], and full endoscopic disc debridement surgery [ 82 ]. Oral therapies for presumed low grade infection affecting the discovertebral complex remain controversial [ 83–87 ]; however, research interest remains as a large RCTs are planned to further determine subpopulations who might benefit from antibiotic treatment [ 88 ].…”