Endplate abnormalities, Modic changes and their relationship to alignment parameters and surgical outcomes in the cervical spine

Baker, James D.; Sayari, Arash J.; Tao, Youping; Louie, Philip K.; Basques, Bryce A.; Galbusera, Fabio; Niemeyer, Frank; Wilke, Hans‐Joachim; An, Howard S.; Samartzis, D

doi:10.1002/jor.25333

Cited by 4 publications

(4 citation statements)

References 52 publications

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“…The initial PubMed search identified 259 articles, after which the title and abstract screening identified 36 potentially relevant articles. Two were excluded due to an inadequate follow-up of less than one year [ 25 , 26 ], another two were excluded because of the risk of potentially identical patients [ 27 , 28 ], and one article’s full-text could not be obtained [ 29 ]. Thirty-one articles were identified after a full-text review.…”

Section: Resultsmentioning

confidence: 99%

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

Lambrechts

Brush

Issa

et al. 2022

IJERPH

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Modic changes (MCs) are believed to be potential pain generators in the lumbar and cervical spine, but it is currently unclear if their presence affects postsurgical outcomes. We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies evaluating cervical or lumbar spine postsurgical outcomes in patients with documented preoperative MCs were included. A total of 29 studies and 6013 patients with 2688 of those patients having preoperative MCs were included. Eight included studies evaluated cervical spine surgery, eleven evaluated lumbar discectomies, nine studied lumbar fusion surgery, and three assessed lumbar disc replacements. The presence of cervical MCs did not impact the clinical outcomes in the cervical spine procedures. Moreover, most studies found that MCs did not significantly impact the clinical outcomes following lumbar fusion, lumbar discectomy, or lumbar disc replacement. A meta-analysis of the relevant data found no significant association between MCs and VAS back pain or ODI following lumbar discectomy. Similarly, there was no association between MCs and JOA or neck pain following ACDF procedures. Patients with MC experienced statistically significant improvements following lumbar or cervical spine surgery. The postoperative improvements were similar to patients without MCs in the cervical and lumbar spine.

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Section: Resultsmentioning

confidence: 99%

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

Lambrechts

Brush

Issa

et al. 2022

IJERPH

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“…52 However, several recent studies suggest that the combined Modic-endplate disruption phenotype results in significantly greater back and neck pain compared to Modic changes independently. 20,45,61 The literature on this phenotype remains extremely limited. However, the clinical impact of concomitant endplate defects and Modic changes may significantly impact patient presentation and serve as a prognostic factor for patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…11,[17][18][19] While the exact etiology of MCs remains unclear, several studies have linked these lesions to both back and neck pain. [20][21][22][23][24] These most frequently occur in the lumbar region. Studies evaluating cervical changes remain limited but have increased in recent years.…”

Section: Introductionmentioning

confidence: 99%

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

Lambrechts

Issa

Toci

et al. 2022

Global Spine Journal

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Study Design Systematic Review. Objectives To systematically review the current literature and perform a meta-analysis on patients with cervical or lumbar spine Modic changes to determine if their baseline axial back pain and disability are comparable to patients without Modic changes. Methods A systematic review of the PubMed database was conducted in accordance with PRISMA guidelines. A meta-analysis was performed to compare the mean differences in back pain, leg pain, and disability based on the presence of cervical or lumbar spine Modic changes. A subgroup analysis of the different types of Modic changes was conducted to determine if Modic type affected back pain or disability. Results – After review of 259 articles, 17 studies were included for meta-analysis and ten studies were included for qualitative synthesis. In the lumbar spine, 10 high-quality studies analyzed Visual Analog Scale (VAS) back pain, 10 evaluated VAS leg pain, and 8 analyzed Oswestry Disability Index. VAS back pain (mean difference (MD), −.38; 95% CI, -.61 – .16) and Oswestry disability index (MD −2.52; 95% CI, −3.93 – −1.12) were significantly lower in patients without Modic changes. Modic change subtype was not associated with differences in patient-reported outcomes. Patients with cervical spine Modic changes did not experience more severe pain than those without MC. Conclusions Modic changes in the lumbar spine are not associated with clinically significant axial low back pain severity or patient disability. Similar to the lumbar spine, Modic changes in the cervical spine are not associated with symptom severity, but they are associated with pain duration.

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“…However, there have been relatively few studies on the relevance between Modic changes and structural abnormalities of the cervical endplate and clinical diseases. In recent years, studies by Harada et al [ 7 ] and Baker et al [ 8 ] revealed that cervical endplate abnormalities can affect the preoperative and postoperative cervical sequence parameters, aggravate postoperative pain following, and increase ASD and reoperation rates. Although the impact of endplate abnormalities on the mechanical stability of the cervical spine was not explored, these studies indicated the importance of the morphological stability of the cervical endplate.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical effect of endplate defects on the intermediate vertebral bone in consecutive two-level anterior cervical discectomy and fusion: a finite element analysis

Zhang

Chen

Weng

et al. 2023

BMC Musculoskelet Disord

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Background Intermediate vertebral collapse is a newly discovered complication of consecutive two-level anterior cervical discectomy and fusion (ACDF). There have been no analytical studies related to the effects of endplate defects on the biomechanics of the intermediate vertebral bone after ACDF. This study aimed to compare the effects of endplate defects on the intermediate vertebral bone biomechanics in the zero-profile (ZP) and cage-and-plate (CP) methods of consecutive 2-level ACDF and to determine whether collapse of the intermediate vertebra is more likely to occur using ZP. Methods A three-dimensional finite element (FE) model of the intact cervical spine (C2–T1) was constructed and validated. The intact FE model was then modified to build ACDF models and imitate the situation of endplate injury, establishing two groups of models (ZP, IM-ZP and CP, IM-ZP). We simulated cervical motion, such as flexion, extension, lateral bending and axial rotation, and compared the range of motion (ROM), upper and lower endplate stress, fusion fixation device stress, C5 vertebral body stress, intervertebral disc internal pressure (intradiscal pressure, or IDP) and the ROM of adjacent segments in the models. Results There was no significant difference between the IM-CP model and the CP model in the ROM of the surgical segment, upper and lower endplate stress, fusion fixation device stress, C5 vertebral body stress, IDP, or ROM of the adjacent segments. Compared with the CP model, the endplate stress of the ZP model is significantly higher in the flexion, extension, lateral bending and axial rotation conditions. Compared with the ZP model, endplate stress, screw stress, C5 vertebral stress and IDP in IM-ZP were significantly increased under flexion, extension, lateral bending and axial rotation conditions. Conclusions Compared to consecutive 2-level ACDF using CP, collapse of the intermediate vertebra is more likely to occur using ZP due to its mechanical characteristics. Intraoperative endplate defects of the anterior lower margin of the middle vertebra are a risk factor leading to collapse of the middle vertebra after consecutive 2-level ACDF using ZP.

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Endplate abnormalities, Modic changes and their relationship to alignment parameters and surgical outcomes in the cervical spine

Cited by 4 publications

References 52 publications

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

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

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

Biomechanical effect of endplate defects on the intermediate vertebral bone in consecutive two-level anterior cervical discectomy and fusion: a finite element analysis

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