Clinical and radiographic outcomes of hybrid graft in patients with Modic changes undergoing transforaminal lumbar interbody fusion

Abstract

Background This retrospective study aimed to analyze the influence of Modic changes (MCs) on the clinical and radiographic outcomes of transforaminal lumbar interbody fusion with hybrid graft. Methods Clinical data of 89 patients with Modic changes who underwent single-segment transforaminal lumbar interbody fusion between January 2015 and January 2019 at our institution were analyzed. Patients were divided into three groups: the MCs-0 group (no endplate changes; used as the control group), the MCs-1 group, and the MCs-2 group. Clinical and radiological parameters were compared between the three groups. Results There were no significant between-group differences in age (P = 0.216), sex (P = 0.903), body mass index (P = 0.805), smoking (P = 0.722), diagnosis (P = 0.758), surgical level (P = 0.760), blood loss (P = 0.172), operative time (P = 0.236), or follow-up (P = 0.372). Serum C-reactive protein level and erythrocyte sedimentation rate in the MCs-1 and MCs-2 groups were significantly higher than those in the MCs-0 group on the third and seventh days (P < 0.05). Postoperative radiographic parameters were significantly higher than preoperative parameters in all 3 groups (P < 0.05). Visual analog scale scores for low back pain in the MCs-0 and MCs-2 groups were significantly different from those in the MCs-1 group (P < 0.05). However, there were no significant between-group differences with respect to Oswestry Disability Index scores or visual analog scale scores for leg pain. Conclusion In this study, Modic changes had no impact on fusion rates and clinical outcomes of transforaminal lumbar interbody fusion with hybrid graft (autologous local bone graft plus allogeneic freeze-dried bone graft). However, MCs-1 increased the risk of cage subsidence and showed superior outcomes in terms of visual analog scale scores for low back pain.

Evaluating the Impact of Modic Changes on Operative Treatment in the Cervical and Lumbar Spine: A Systematic Review and Meta-Analysis

“…Nine studies evaluating lumbar fusion surgery were identified. One study evaluated oblique lateral interbody fusions (OLIF) [ 43 ], two evaluated transforaminal lumbar interbody fusions (TLIFs) [ 23 , 40 ], two included multiple fusion techniques [ 51 , 56 ], two evaluated PLIF [ 42 , 47 ], and two evaluated posterolateral fusions [ 48 , 58 ]. In general, patients had substantial improvements in the clinical outcomes and fusion rates regardless of the presence of MCs, with the exception of one study, which found decreased fusion rates and worse outcomes in patients with type III MCs [ 58 ].…”

“…Jiao et al [ 40 ] retrospectively identified 89 patients, 51 with MC, who underwent single-level TLIFs. The authors found no difference in the fusion rate or clinical outcomes based on MCs, but type I MCs were associated with significantly higher rates of cage subsidence (40% to 15.8%).…”

“…These studies demonstrated that MC do not influence patient-reported outcomes or fusion rates following lumbar fusion surgery regardless of approach. Jiao et al [ 40 ] identified that patients with type I MC experienced greater improvement in PROs following TLIF. Kwon et al [ 58 ] reported lower fusion rates and worse PROs in type III MC.…”

Modic Changes of the Cervical and Lumbar Spine and Their Effect on Neck and Back Pain: A Systematic Review and Meta-Analysis

“…After stratification by MC subtype, nine studies were included that reported on leg pain in patients without Modic changes, 29,30,32,33,35,36,38,39,42 ten examined patients with MC-I, 29,30,32,33,35,36,38,39,41,42 and eight reported on leg pain in patients with MC-II. 29,30,32,33,36,39,41,42 Forest plots revealed a high degree of data heterogeneity (I 2 = 61%, P < .01). MC subtypes were not significantly associated with difference in VAS leg scores ( P = .38) (Supplemental Figure 3).…”

“…Pooled reports of back pain intensity among patients with and without MC were reported in 10 studies. 24,[29][30][31][32][33][34][35][36][37][38][39] Low back pain intensity scores were standardized on a 0-10 scale. An initial funnel plot revealed possible publication bias in three studies 15,29,30 After these studies were excluded, a forest plot revealed low data heterogeneity (I 2 = 21%, P = .25) (Figure 2A).…”