Spontaneous Resorption of Lumbar Disc Herniation Is Less Likely When Modic Changes Are Present

Shan, Zhi; Fan, Shunwu; Xie, Qingbo; Suyou, Letu; Liu, Junhui; Wang, Chongyan; Zhao, Fengdong

doi:10.1097/brs.0000000000000259

Cited by 78 publications

(64 citation statements)

References 35 publications

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“…IDH volume decreased from 1433.89 ± 525.49 mm 3 to 1002.01 ± 593.95 mm 3 , resulting in an average resorption rate of 27.25 ± 32.97%, and 20 patients presented resorption rates of ≥50% [10]. While modic change was not recognized as a predictive factor of resorption in this study, a 2014 study by Shan et al reported that whereas 35 of 85 patients in the modic change group (of whom the majority were of Type 2) did not show much difference in IDH size, the group with no modic change displayed significant decrease [32]. Iwabuchi et al purported that resorption factors could be identified on T1- and T2-weighted MRIs, with high signal intensity of IDH areas in T1- and T2-weighted MRIs in the nonregression group [33].…”

Section: Discussionmentioning

confidence: 71%

Long‐Term Course to Lumbar Disc Resorption Patients and Predictive Factors Associated with Disc Resorption

Lee

Kim

Shin

et al. 2017

Evidence-Based Complementary and Alternative Medicine

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The long-term course to lumbar intervertebral disc herniation (LDH) patients receiving integrative Korean medicine treatment and predictive factors associated with disc resorption were investigated. LDH patients who received integrative Korean medicine treatment from February 2012 to December 2015 and were registered in the “longitudinal project for LDH on MRI” were included. Disc resorption amount was measured 3-dimensionally with disc degeneration and modic change levels on baseline and follow-up MRIs. Patient characteristics, Korean medicine use, pain, symptom recurrence, and satisfaction were assessed through medical records and phone surveys. Of 505 participants, 19 did not show disc resorption, while 486 did. A total of 220 displayed resorption rates of ≥50%. LDH volume at baseline was 1399.82 ± 594.96 mm3, and that on follow-up MRI was 734.37 ± 303.33 mm3, indicating a 47.5% decrease (p < 0.0001). Predictive factors for disc resorption were disc extrusion, Komori migration classification, and LDH amount. Approximately 68.4% did not experience symptom recurrence over the 51.86 ± 19.07-month follow-up, and 90.3% were satisfied with Korean medicine treatment. The majority of LDH patients who improved after integrative Korean medicine treatment showed disc resorption within 1 year with favorable long-term outcomes. Predictive factors for disc resorption should be duly considered for informed decision-making. This trial is registered with ClinicalTrials.gov NCT02841163.

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Section: Discussionmentioning

confidence: 71%

Long‐Term Course to Lumbar Disc Resorption Patients and Predictive Factors Associated with Disc Resorption

Lee

Kim

Shin

et al. 2017

Evidence-Based Complementary and Alternative Medicine

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“…; Shan et al. ). Other studies have argued that any potential positive correlation between cartilage endplate herniations and pain and clinical symptoms will be confounded by the inflammatory effect of the nucleus material in the extrusion (Joe et al.…”

Section: Discussionmentioning

confidence: 98%

“…; Shan et al. ). It has been suggested that non‐virulent anaerobic bacteria can infect the disc at the time of herniation.…”

Section: Discussionmentioning

confidence: 98%

How maturity influences annulus‐endplate integration in the ovine intervertebral disc: a micro‐ and ultra‐structural study

2016

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The annulus-endplate anchorage system plays a vital role in structurally linking the compliant disc to its adjacent much more rigid vertebrae. Past literature has identified the endplate as a region of weakness, not just in the mature spine but also in the immature spine. The aim of this structural study was to investigate in detail the morphological changes associated with annulus-endplate integration through different stages of maturity. Ovine lumbar motion segments were collected from two immature age groups: (i) newborn and (ii) spring lamb (roughly 3 months old); these were compared with a third group of previously analysed mature ewe samples (3-5 years). Sections from the posterior region of each motion segment were obtained for microstructural analysis and imaged in their fully hydrated state via differential interference contrast (DIC) optical microscopy. Selected slices were further prepared and imaged via scanning electron microscopy (SEM) to analyse fibril-level modes of integration. Despite significant changes in endplate morphology, the annular fibre bundles in all three age groups displayed a similar branching mechanism, with the main bundle splitting into several sub-bundles on entering the cartilaginous endplate. This morphology, previously described in the mature ovine disc, is thought to strengthen significantly annulus-endplate integration. Its prevalence from an age as young as birth emphasizes the critical role that it plays in the anchorage system. The structure of the branched sub-bundles and their integration with the surrounding matrix were found to vary with age due to changes in the cartilaginous and vertebral components of the endplate. Microscopically, the sub-bundles in both immature age groups appeared to fade into the surrounding tissue due to their fibril-level integration with the cartilaginous endplate tissue, this mechanism being particularly complex in the spring lamb disc. However, in the fully mature disc, the sub-bundles remained as separate entities throughout the full depth of their anchorage into the cartilaginous endplate. Cell morphology was also found to vary with maturity within the cartilaginous matrix and it is proposed that this relates to endplate development and ossification.

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“…New research results have shown that in patients with disc herniations the ingrowth of capillaries and inflammatory mechanisms may be important ingredients of the development of pain and MC in the involved spinal structures [14]. Additional observations point to a possible association between the high proportion of hyaline cartilage in the herniated disc mass and the development of MC in the adjacent segments [15]. As the bony endplates normally have a rich supply of small free nerve endings, degenerative developments and inflammation can trigger a localized inflammatory pain pattern [5,16].…”

Section: Etiology and Painmentioning

confidence: 97%

Vertebral endplate (modic) changes and the treatment of back pain using antibiotics

Manniche¹

2014

Clinical Practice

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Practice points• Vertebral endplate changes/modic changes (MC) are the MRI-images of inflammatory vertebral endplate damage that are often related to general disc degeneration. • In patients with prolonged back pain, the prevalence of MC is 40%.• In individuals with MC, more than 90% will have back pain within 1 year.• MC often causes localized pain 24/7. • Nocturnal pain is the rule rather than the exception.• New MC type 1 occurs frequently during the course of a disc herniation.• There are currently no better diagnostic methods in MC than MRI and a case story of the typical inflammatory back pain pattern and the likely presence of a disc herniation within the recent few years. • In biopsies from prolapsed disc mass, bacteria -most commonly Propionibacterium acnes of the oral cavity class -are found in at least 40% of patients. • In a MC subgroup with persistent back pain after a disc herniation and emerging MC type 1, it is relevant to consider: 'disc infection'. • In one high quality RCT, including a subgroup of post-prolapse/MC patients with chronic pain, demonstrated clinically significant improvements in more than 50% of the patients after 3 months of treatment with a broad spectrum antibiotic. • MC type 1 are generally considered to be an important prognostic marker of a poor prognosis.Vertebral end-plate changes/modic changes are the MRI-image of inflammatory vertebral endplate damage, most often related to general disc degeneration. However, in a subgroup of patients disc infection may be the causal factor. In patients with prolonged back pain, the prevalence of modic changes (MC) is 40%. In most cases, nocturnal pain is the rule and MC causes highly localized pain 24/7. There are currently no better diagnostic methods than MRI and case history findings. In persistent back pain after a disc herniation and emerging MC type 1, it is relevant to consider: 'disc infection'. Most commonly, Propionibacterium acnes is involved. Long-term antibiotics may be effective. Keywords: antibiotics • back pain • chronic pain • disc prolapse • discitis • modic changes • vertebral endplateModic et al. [1] defined three types of vertebral endplate (modic) changes as visualized on MRI in 1988 and in 2001, Stirling [2] cultured bacteria in disc biopsies from more than 50% of patients investigated who had undergone surgery for a prolapsed disc. By combining these findings researchers from The Spine Center of Southern Denmark established a hypothesis in 2008 regarding MC including its prevalence, etiology,

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Spontaneous Resorption of Lumbar Disc Herniation Is Less Likely When Modic Changes Are Present

Abstract: 3.

Cited by 78 publications

References 35 publications

Long‐Term Course to Lumbar Disc Resorption Patients and Predictive Factors Associated with Disc Resorption

Long‐Term Course to Lumbar Disc Resorption Patients and Predictive Factors Associated with Disc Resorption

How maturity influences annulus‐endplate integration in the ovine intervertebral disc: a micro‐ and ultra‐structural study

Vertebral endplate (modic) changes and the treatment of back pain using antibiotics

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