New insights into the natural course and clinical relevance of Modic changes over 2 years following lumbar limited discectomy: analysis of prospective collected data

Abstract

Purpose Few retrospective studies have addressed Modic changes (MC) following lumbar spine surgery, though it is usually assumed that MC increase in grade and incidence. To test this conventional wisdom, we investigated the natural course of MC following primary lumbar limited discectomy with two-year follow-up. In addition, a possible clinical relevance to those changes was assessed. Methods The data of the control group (278 subjects) of a prospective randomized, controlled trial (RCT) were evaluated retrospectively. Results We did not observe a simple increase in MC with regard to grade. There is variable activity observed in Type 2 (at 12 months) and in Type 1 (at 24 months). Conversion from one grade to another may occur and may be upward or downward. The incidence of MC increased slightly over time, as after surgery a decreasing percentage of the study group remained without MC over two years (1 year: 34% (85/250); 2 years: 30% (72/237)). Radiological parameters (rotation, translation, and spondylolisthesis) had no significant correlation to MC or MC subtypes. Lastly, we found that neither the different MC types nor their changes were correlated with clinical parameters (VAS back, VAS leg, ODI score) preoperatively or during follow-up. Conclusion The pattern of Modic changes following lumbar limited discectomy is complex, not simply increasing. There is variable activity in MC Types 1 and 2 at the different time points of follow-up, and conversion from a higher grader to a lower one or vice versa is possible. Graphical abstractThese slides can be retrieved under Electronic Supplementary Material. Key points 1. Although Modic changes (MC) have widely investigated in conservative treatment, few retrospective studies have addressed Modic changes following lumbar spine surgery. 2. Usually it is assumed, that Modic changes should increase in quality and quantity.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Affiliations

Lumbar intervertebral disc degeneration, end-plates and paraspinal muscle changes in children and adolescents with low-back pain

“…Modic changes do not upgrade from Modic 0 to Modic 3 in a simple manner as predicted. Recently, Bostelmann et al [29] observed upgrading and downgrading of Modic changes in patients who were followed up for 2 years after lumbar discectomy. However, our knowledge regarding Modic changes in children and adolescents is still limited.…”

Comparison of Percutaneous Transforaminal Endoscopic Decompression and Transforaminal Lumbar Interbody Fusion in the Treatment of Single-Level Lumbar Disc Herniation with Modic Type I Changes

“…In the treatment of cases with MC, previous studies have also reported successful results. Bostelmann et al 24 retrospectively analyzed the clinical data of 278 patients undergoing discectomy and they found that different types of MC were not associated with clinical outcomes. Udby et al 23 conducted a 2-year follow-up study and found that MC was not associated with quality of life, pain, or patient satisfaction at 2 years after discectomy.…”

The effects of lumbar fusion and non-fusion surgery on the development of Modic changes

“…We speculate that it may be associated with the increase in fatty degeneration of the vertebral subchondral bone marrow caused by lumbar surgery [9]. However, a recent new insight tends to consider that the pattern of MCs following lumbar discectomy is complex and not simply increasing [8].…”

“…For patients with lumbar degenerative disease, several common surgeries including discectomy, sequestrectomy, decompression, and fusion are currently proven safe and effective. However, these surgical procedures seem to directly alter the biomechanical forces on a microstructural level and predispose the adjacent vertebral bodies to MCs [8], especially in the case of a disrupted disc/an injured annulus fibrosus. The influence of different surgical techniques on endplate changes may be different [6].…”