Curative Effect Analysis Of The Posterior Spinal Fusion Surgery For The Lumbar Spine Disc Degeneration Disease With Modic Change

ObjectiveTo evaluate the curative effect of the posterior spinal fusion surgery for the lumbar spine disc degeneration disease with type Ⅰ and Ⅱ Modic change.MethodsA retrospective review study of all lumbar spine disc degeneration disease patients with type Ⅰ 、Ⅱ Modic change or no Modic change that treated operatively between January 2012 and September 2013. A total of 57 patients were found that met our inclusion criteria;17 were type Ⅰ,46 were type Ⅱ and we selected 20 of them randomly;73 were control group that without Modic change and we selected 20 of them randomly. All of them receive standard posterior interbody fusion and pedicle fixation surgery. The indicators include Cobb angle、the distance of the upper and under end plate of the operation section、the rate of fusion、the VAS、IOD、JOA score preoperative and postoperation to evaluate the curative effect.ResultsA total of 57 patients finished the follow-up study, the mean age is 45± 6.9 years old. The operation time of the type Ⅰ group were lower compare to the type Ⅱ group (P=0.027) and the control group(P=0.024). The type Ⅱ group were older than the type Ⅰ group (P=0.000) and the control group (P=0.034). No significant difference was found in the blood loss of the three groups. The preoperative VAS and ODI scores were found significant higher in the type Ⅰ group compare to the other two groups. There was no remarkable difference in preoperative JOA score between three groups. The improvement of VAS and ODI scores were better in the type Ⅰ group, the type Ⅱ group was similar to the control group. The Cobb’s angle and the distance of the upper and under end plates of the three groups was significant increase after the operation, but in the last follow-up, The Cobb’ s angle were found significant decrease. The fusion rate in each group at six months after the operation was 70.5% in type 1,70% in type Ⅱ, and 85% in the control group. At the last follow-up, the rate was 88.2% in type Ⅰ,90% in type Ⅱ, and 95% in the control group.5.8%(1/17)、 10%(2/20)、5%(1/20).ConclusionClinical results were found to be better in the type I group than the other two. The fusion rate was similar between in type Ⅰ and type Ⅱ group at six months after the operation, but lower than the control group. The last fusion rate was very similar. The ratio of collapse of the endplate was seemed higher in type Ⅰ and type Ⅱ group. The preliminary conclusion is that the type Ⅰ had a better clinical result than other two. The fusion was similar, but it seemed to take a longer time to achieve in type Ⅰ and type Ⅱ group, and the risk of collapse of the endplate was higher too. We suggested that more attention should be payed when you deal with the cartilage endplates, and make sure not to remove excessive cancellous bone under the endplates.