Success of Lumbar Microdiscectomy in Patients With Modic Changes and Low-back Pain

Chin, Kingsley R.; Tomlinson, Daniel; Auerbach, Joshua D.; Shatsky, Joshua B.; Deirmengian, Carl

doi:10.1097/bsd.0b013e318093e5dc

Cited by 44 publications

(11 citation statements)

References 14 publications

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“…Similar to our study, Sorlie found that patients with Modic Type 1 changes had worse outcomes on the ODI and the EQ-5D after surgery[17]. In addition, a prospective case controlled study by Chin found that persons with IDH and no Modic changes did better after surgery [15]. These consistent findings suggest that Modic Type 1 changes may denote a pathologic source of radicular pain that is distinct from the disc herniation per se and therefore may not improve following discectomy.…”

Section: Discussionsupporting

confidence: 85%

“…Other studies have looked at the effect of vertebral endplate or so-called Modic changes in patients with IDH and found that patients with baseline type 1 Modic changes have worse surgical outcomes [15–17]. To date however, no studies have looked systematically at a broad range of MRI findings as potential predictors of outcome for both surgical and non-operatively treated patients with IDH.…”

Section: Introductionmentioning

confidence: 99%

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Magnetic Resonance Imaging Predictors of Surgical Outcome in Patients With Lumbar Intervertebral Disc Herniation

Lurie¹,

Moses

Tosteson

et al. 2013

Spine

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Study Design A retrospective cohort design Objective To determine if baseline MRI findings including central/foraminal stenosis, Modic change, disc morphology, facet arthropathy, disc degeneration, nerve root impingement, and thecal sac compression are associated with differential surgical treatment effect. Summary of Background Data Intervertebral Disc Herniation (IDH)remains the most common source of lumbar radiculopathy treated either with discectomy or non-operative intervention. Although MRI remains the reliable gold standard for diagnosis, uncertainty surrounds the relationship between MRI findings and treatment outcomes. Methods Three-hundred-and-seven “complete” images from patients enrolled in a previous trial were de-identified and evaluated by one of 4 independent readers. Findings were compared to outcome measures including the Oswestry Disability Index. Differences in surgery and non-operative treatment outcomes were evaluated between image characteristic subgroups and TE determined by the difference in ODI scores. Results The cohort was comprised of 40% females with an average age of 41.5 (±11.6), 61% of which underwent discectomy for IDH. Patients undergoing surgery with Modic type I endplate changes had worse outcomes (−26.4 versus −39.7 for none and −39.2 for type 2, p=0.002) and smaller treatment effect (−3.5 versus −19.3 for none and −15.7 for type 2, p=0.003). Those with compression >=1/3 showed the greatest improvement within the surgical group (−41.9 for >=1/3 versus −31.6 for none and −38.1 for <1/3,p=0.007), and the highest TE (−23 compared to −11.7 for none and −15.2 for <1/3, p=0.015). Furthermore, patients with minimal nerve root impingement demonstrated worse surgical outcomes(−26.5 versus −41.1 for “displaced” and −38.9 for “compressed”, p=0.016). Conclusion Among patients with IDH, those with thecal sac compression >=1/3 had greater surgical treatment effect than those with small disc herniations and Modic type I changes. Additionally, patients with nerve root “compression” and “displacement” benefit more from surgery than those with minimal nerve-root impingement.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Magnetic Resonance Imaging Predictors of Surgical Outcome in Patients With Lumbar Intervertebral Disc Herniation

Lurie¹,

Moses

Tosteson

et al. 2013

Spine

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“…Various treatments for patients with LDH combined with MC at the same level have been discussed, but the outcomes remain controversial. Chin et al [ 15 ] reported significant improvement after nonfusion in minimally invasive discectomy, and suggested later fusion for younger patients, while Ohtori et al [ 16 ] suggested fusion surgery for patients with MC and hypermobility. Until now, few studies have reported surgical treatment for revision of LDH recurrence after PELD in patients with MC.…”

Section: Discussionmentioning

confidence: 99%

Recurrent lumbar disc herniation recurrence after percutaneous endoscopic lumbar discectomy

Wang¹,

Cong²,

Xu³

et al. 2018

Medicine

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Rationale:Lumbar disc herniation (LDH) is a degenerative disease and affects human health. Although percutaneous endoscopic lumbar discectomy (PELD) can redeem the living quality of patient with LDH rapidly, it appears weak to limit the recurrence rate of LDH.Patient concerns:A 52-year-old male suffered lower back pain and lower limb paralysis for 20 years. However, conservative treatment could not relieve above-mentioned symptoms after doing heavy labor.Diagnoses:Computed tomography (CT) revealed a disc fragment had migrated to the inferior edge of the L5 pedicle. Magnetic resonance imaging (MRI) demonstrated a type 2 Modic change (MC) at L5 and spinal canal stenosis at L4-L5. Based on these findings, the patient was diagnosed with L4-L5 disc herniation and secondary lumbar stenosis.Interventions:The patient underwent surgery twice for PELD at L4-L5 in 1 month. Symptoms were not improved effectively until the conventional posterior discectomy with fusion was performed.Outcomes:No signs of recurrence have been detected in 6 months of follow-up, except for mild lower back pain meeting the temperature change.Lessons:Rapid decompression and instant therapeutic effect do not mean extending the indications of PELD. It is unreasonable to revise the recurrent LDH or treat the primary LDH with PELD under inadequate preoperative assessment.

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“…These studies attempting to predict outcomes of both conventional and microsurgical disc surgery based on disc size measured on MRI studies have produced inconsistent findings [ 16 ]. Location of the disc, disc space narrowing, the presence of larger eccentric disc fragments, the degree of narrowing or compromise of the axial spinal canal and associated bone changes, especially around the facet joints, are some of the findings examined to analyze how they affect outcomes [ 17 - 19 ] (Figure 3 ).…”

Section: Reviewmentioning

confidence: 99%

“…A long-term eight-year MRI follow-up study showed that despite resolution of symptoms, frequently the post-procedure MRI did not change in as many as 65% of cases over 12 months and actually decreased in only 17.5% [ 16 ]. Preoperatively, finding more than 1/3 decrease in axial canal size was a better predictor of outcomes compared to only small herniations and Modic change with endoscopic or microdiscectomy lumbar surgery [ 16 - 17 ]. Large disc herniations and extruded or free fragments were clearly seen in cases with large decreases in canal dimensions [ 18 - 19 ].…”

Section: Reviewmentioning

confidence: 99%

Selection of Tubular and Endoscopic Transforaminal Disc Procedures Based on Disc Size, Location, and Characteristics

Palea¹,

Granville²,

Jacobson³

2018

Cureus

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The clinical effectiveness of percutaneous and transforaminal endoscopic discectomy procedures has been evaluated by the system used or compared to open laminectomy or micro-discectomy but are not evaluated based on the location and characteristics of the abnormal disc. This review proposes that outcomes are primarily related to disc size, biomechanics, location, and associated segmental fibrotic and bone changes as well as the surgeon's skill in using various systems rather than the specific system used. In these cases, the surgeon needs to decide if the goal of the procedure is simply internal decompression of an abnormal but contained herniated disc or release of the entrapped nerve root by a large contained disc, extruded and migrated disc fragment, or coexistent foraminal stenosis. Percutaneous and tubular transforaminal procedures are quite different, technically ranging from simple discectomy aspirating probes to larger endoscopic systems, providing the capability to remove large extruded free disc fragments, with or without foraminotomy. Recently, the ability to perform interbody fusion has been added to the range of procedures able to be performed endoscopically. At the same time, biologic solutions to disc degeneration are rapidly evolving and may have a place in combination with these procedures. This article reviews the interrelationship between clinical signs and symptoms, radiologic findings, and the biochemistry and biomechanics of the affected disc segment. Understanding the role played by all these factors enables the surgeon to evaluate both the disc and surrounding bone structures pre-operatively to determine if the clinical signs and symptoms are related to enlargement and displacement of a contained disc or compression or impingement of the nerve root. Based on this, the surgeon can choose different surgical systems, allowing simple decompression of a contained disc, possibly adding biologics, with a 'small' system, while a large herniated disc, or extruded fragment, causing root impingement, would require a ‘larger’ system that provides direct endoscopic visualization within the epidural space, foraminal decompression with drills, and direct surgical manipulation and freeing of the nerve root. By choosing the surgical system based on characteristics such as disc size, location, and associated inflammatory and fibrotic changes, the effectiveness of minimally invasive procedures will be more consistent and improve as the surgeon's diagnostic and operative skills improve.

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Success of Lumbar Microdiscectomy in Patients With Modic Changes and Low-back Pain

Abstract: Therapeutic II.

Cited by 44 publications

References 14 publications

Magnetic Resonance Imaging Predictors of Surgical Outcome in Patients With Lumbar Intervertebral Disc Herniation

Magnetic Resonance Imaging Predictors of Surgical Outcome in Patients With Lumbar Intervertebral Disc Herniation

Recurrent lumbar disc herniation recurrence after percutaneous endoscopic lumbar discectomy

Selection of Tubular and Endoscopic Transforaminal Disc Procedures Based on Disc Size, Location, and Characteristics

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