| Objective: To analyze the surgical outcomes in patients of lumbar disk herniation(LDH)combined with Modic changes(MCs)and evaluate the impotance of Modic changes in different segments and types to the efficacy of instrumented posterior lumbar interbody fusion(i PLIF),with the expectation of improving the therapeutic effect of lumbar disc disease.Methods: The retrospective study included 118 patients with lumbar disk herniation(LDH)treated with instrumented posterior lumbar interbody fusion(i PLIF)during 2016.1 to 2016.9 in Hebei Medical University NO.3 hospital while lumbar spine X-ray and MRI images were conducted preoperatively among all individuals.Pfirrmann grades of intervertebral disks were scored to evaluate the degeneration.Sagittal T2WI-weighted MRIs of the lumbar endplates were assessed for the presence of MCs.The area of MCs and vertebrae was measured on the most obvious sagittal T2W1-weighted images,meanwhile the signal change rates were obtained(mean value of signal change rates were computed in the condition that there were multiple MCs existed in one intervertebral segments).All individuals were divided into three categories.Group A:MCs only presented in the endplates of surgical segments;Group B:MCs presented in the lumbar endplates without surgical intervention;Group C: No MCs in lumbar spine.Visual Analogue Scale(VAS)pre-and post-operative three months was recorded and aplied to evaluate the improvement of the low back pain and radicular pain.Functional evaluation was made as well mainly by Oswestry Disability Index(ODI).Correlation between clinical improvement and location of MCs was analyzed.Results: 118 individuals were followed up at postoperative threemonths.Group A :35cases;Group B:23cases;Group C:60cases;mean age was 52.36±12.41 years,including 40 males(51.73±13.97yrs)and 78 females(52.69±11.60yrs).Involved lumbar intervertebral segments : 590 cases.The prevalence of MCs was 49.2%(n=58)in all patients.Among them,6cases(5.1%)were type1;40 cases(33.9%)were type2;12 cases were type 3(10.2%).The amount of segments with disc height narrowing(Pfirrmann grade ⅣorⅤ): L1-2:17,L2-3:23,L3-4:36,L4-5:91,L5-S1:86.The amount of involved with MCs in lumbar spine L1-2:2,L2-3:6,L3-4:9,L4-5:25,L5-S1:16.Disc degeneration and endplate MCs were both most common in L4-5 and L5-S1 which show a significant correlation(χ2=54.662,P=0.000).No significant difference existed among the three groups involved age,gender,severity of preoperative symptom.All patients treated with i PLIF had witnessed a significant improvement of clinical symptom(P<0.05)and there were no significant difference in age,gender,preoperative symptom among group A /B/C.VAS(back pain)improvement rates of the three groups were:(76.42±13.72)% vs(54.06±14.38)% vs(73.72±15.42)%.VAS(leg pain)improvement rates were:(84.83±10.81)% vs(81.17±12.98)% vs(83.42±12.79)% while ODI improvement rates were:(67.23±5.85)% vs(57.43±3.11)% vs(69.93±6.93)%.No significance existed in VAS(leg pain)among three groups,however,VAS(back pain)and ODI improvements in group B were lower than the other two groups(P<0.05).Area of MCs in T2W1 sagittal MRI in group A/B were 222.75±125.66(mm2)vs220.26±186.03(mm2)and the change rates were(19.90±8.50)% vs(17.72±7.67)%.Correlation existed between the sagittal area change rates with preoperative ODI & VAS(back pain)improvement rates(RODI=0.512,P=0.039;RVAS=0.208,P=0.114),however,statistic significance was not reach in correlation between VAS(back pain)and the sagittal area change rates.Among three types,patients with typeⅢ MCs tend to worse clinical outcomes whether in group A or B.Conclusions:1 Lumbar endplate MCs were common in patients with LDH which showed correlation between degenerative disc disease and MCs.2 iPLIF was an effective treatment for patients with LDH involved with MCs which predicted a ideal clinical outcome by improvement in radicular pain and low back pain.3 MCs without fusion(most in jacent segments in this investigation)were more likely resulted in postoperative low back pain,possibly caused by more severe postoperative degeneration of endplates and discs.4 Area of MCs in T2-weighted saggital MRI and their change rates showed more correlation with preoperative ODI as well as the improvement rates. |
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