Asymmetric And Symmetric Distribution Of Modic Changes In Patients With Lumbar Disc Herniation

Objective:This study proposes a simplified intra-endplate Modic change distribution pattern:asymmetric and symmetric distribution.The aim of this study is to explore the imaging characteristics,correlative factors and clinical outcomes of asymmetric and symmetric distribution in patients with lumbar disc herniation(LDH),as well as the relationship between Modic changes and lumbar disc herniation.Methods:Among the patients admitted to the Third Hospital of Hebei Medical University from January 2017 to December 2019,a total of 289patients with LDH combined with single-segment Modic changes were included in this study.Demographic and clinical data were collected,including age,gender,body mass index(BMI),smoking,low back pain(LBP),leg pain,duration of pain,and whether to accept surgical treatment.All patients underwent 1.5T lumbar MRI examination to evaluate the type of Modic changes,asymmetric and symmetric Modic changes,lumbar disc herniation and lumbar disc degeneration.The clinical outcomes of patients undergoing surgical treatment were evaluated before surgery and at the final follow-up.The visual analog score(VAS)was evaluated on low back pain and leg pain,and Oswestry disability index(ODI)on neurological function.Results:All 289 patients included 197 cases(68.17%)of Asymmetric Modic changes(AMCs)and 92 cases(31.83%)of symmetric Modic changes(SMCs).AMCs was more likely to be associated with leg pain(X~2=15.59,P<0.001).There was no significant difference in the effects of AMCs and SMCs on LBP(X~2=0.230,P=0.931)and duration of pain(t=0.957,P=0.339).The surgical rate of AMCs patients was higher than SMCs patients,and the difference was statistically significant(X~2=4.873,P=0.027).There was no significant difference in age,gender,BMI and smoking between AMCs group and SMCs group(all P>0.05).The difference of the location of LDH between AMCs group and SMCs group was statistically significant(X~2=60.885,P<0.001),while there was no significant difference in the type of Modic change,lumbar disc degeneration and the size of LDH(all P>0.05).The multivariate logistic regression analysis showed leg pain(OR=2.169,P=0.009),asymmetric disc herniation(OR=7.342,P<0.001)were independent related to AMCs.A total of 102 patients received surgical treatment,and the total surgical rate was 35.29%.The VAS of leg pain was higher in AMCs group(6.41±2.75)than in SMCs group(5.00±3.27)before surgery(t=2.421,P=0.017),while there was no significant difference between the two groups at the final follow-up(t=0.273,P=0.785).There was no significant difference in VAS of LBP and ODI between the two groups before surgery and at the final follow-up(all P>0.05).The VAS of LBP,VAS of leg pain and ODI in both two groups at the final follow-up were significantly lower than those before surgery(all P<0.001).Conclusions:Asymmetric Modic changes were a more common phenomenon than symmetric Modic changes.The location of Modic changes were closely related to the location of LDH.Asymmetric Modic changes were associated with leg pain and its severity.Satisfactory clinical outcomes were obtained in the surgical treatment of both asymmetric and symmetrical Modic changes.