A Study On The Impact Of Modic Changes On The Interbody Fusion Rate After TLIF In Patients With Lumbar Spinal Stenosis

Objective:Explore the effect of Modic changes(types Ⅰ,Ⅱ,Ⅲ)on the 6-month intervertebral fusion rate after TLIF surgery(lumbar interbody fusion through intervertebral foramen).Methods:The aim of this study is to investigate the effect of Modic changes(types Ⅰ,Ⅱ,Ⅲ)on the fusion rate of lumbar interbody fusion through the intervertebral foramen approach(TLIF surgery)after 6 months.The study subjects were patients with lumbar spinal stenosis who underwent TLIF surgery at Bayannur City Hospital from December 2020 to December 2022.The diagnostic criteria for lumbar spinal stenosis were intermittent claudication,limited lumbar extension and pain,root symptoms,and a sagittal diameter of less than 13 mm observed on CT or MRI.After screening with inclusion and exclusion criteria,a total of 93 patients were selected.According to the type of Modic changes,patients were divided into four groups:32 patients without Modic changes(17 males and 15 females),20 patients with Modic Type Ⅰ changes(11 males and 9 females),31 patients with Modic Type Ⅱ changes(17 males and 14 females),and 10 patients with Modic Type Ⅲ changes(5 males and 5 females).All patients underwent TLIF surgery.Collect lumbar three-dimensional reconstruction CT images of all enrolled patients 6 months after surgery,and evaluate and grade the effectiveness of intervertebral fusion.The intervertebral fusion grade is evaluated and graded by an experienced deputy chief physician in the department using Mayer’s fusion evaluation method.In addition,collect basic information of patients,including age,gender,hospital bed number,lesion segment,surgical time,intraoperative bleeding volume,complications,and hospitalization time,and conduct a 6-month follow-up observation.By comparing the intervertebral fusion rate between patients without Modic changes and the other three groups of patients,we explore the impact of Modic changes on the intervertebral fusion effect after TLIF surgery.Results:The total number of follow-up patients was 93.Six months after surgery,lumbar three-dimensional reconstruction CT reexamination was performed.The CT results showed that in the group without Modic changes,the fusion rate between grade Ⅱvertebral bodies was 25/32(78.1%),and the fusion rate between grade Ⅲ vertebral bodies was 7/32(21.9%);In the group of patients with combined Modic type Ⅰ changes,the fusion rate between grade Ⅱ vertebral bodies was 8/20(40.0%),and the fusion rate between grade Ⅲ vertebral bodies was 12/20(60.0%);In the group of patients with combined Modic type Ⅱ changes,the fusion rate between grade Ⅱ vertebrae was 23/31(74.2%),and the fusion rate between grade Ⅲ vertebrae was 8/31(25.8%);In the group of patients with combined Modic Ⅲ changes,the fusion rate between grade Ⅱ vertebral bodies was 7/10(70.0%),and the fusion rate between grade Ⅲ vertebral bodies was 3/10(30.0%).There was a significant difference(P=0.005<0.017)between the group without Modic changes and the group with Modic Type Ⅰ changes in the fusion rates of grade Ⅱ and grade Ⅲ intervertebral bodies;There was no significant difference(P=0.714>0.017)in the level Ⅱ and level Ⅲ interbody fusion rates between the group without Modic changes and the group with Modic type Ⅱ changes.There was also no significant difference(P=0.919>0.017)in the level Ⅱ and level Ⅲ interbody fusion rates between the group without Modic changes and the group with Modic type Ⅲ changes.The fusion rate between vertebral bodies was lower in patients in the group with Modic type Ⅰ changes 6 months after surgery.There were no significant differences in gender(P=0.993>0.05),age(P=0.393>0.05),intraoperative bleeding(P=0.861>0.05),and surgical time(P=0.171>0.05)among the four groups.Conclusion:This study found that Modic Type Ⅰ,Ⅱ,and Ⅲ changes have different effects on the rate of interbody fusion after TLIF surgery in patients with lumbar spinal stenosis.Among them,there is a significant difference between Modic Type Ⅰ changes and intervertebral fusion rate,while Modic Type Ⅱ and Ⅲ changes have no significant correlation with intervertebral fusion rate.This indicates that for patients with Modic type Ⅰ changes,attention and management of intervertebral fusion should be strengthened to improve surgical outcomes and patient recovery.For patients with Modic type Ⅱ and Ⅲ changes,there is no need to overly share the issue of interbody fusion,but attention should still be paid to the risk of related complications.