What happens to Modic changes following lumbar discectomy? Analysis of a cohort of 41 patients with a 3- to 5-year follow-up period

Clinical article

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Object

The natural history of Modic changes (MCs) in the lumbar spine is often marked by conversion from one type to another, but their course following lumbar discectomy remains unknown. The authors sought to study the impact of surgery on the natural history of these lesions.

Methods

Forty-one patients treated with lumbar microdiscectomy between 2004 and 2005 were enrolled in this study and underwent clinical evaluation and repeat MR imaging after a median follow-up of 41 months (range 32–59 months). Preoperative and follow-up MR images were reviewed and the type, location, and extent of MCs at the operated level were recorded and compared.

Results

The study population consisted of 27 men and 14 women with a mean age of 54 years (range 24–78 years). During the follow-up period, the prevalence of MCs increased from 46.3% to 78%, and 26 patients (63.4%) had Type 2 lesions at the operated level. Of the 22 patients without MCs, 4 (18.2%) converted to Type 1 and 9 (40.9%) to Type 2. Of the 5 Type 1 lesions, 3 (60%) converted to Type 2, and 2 (40%) remained Type 1 but increased in size. In contrast, none of the 14 Type 2 changes converted to another type, although 10 (71.4%) increased in extent. There were no reverse conversions to Type 0.

Conclusions

Following lumbar discectomy, most patients develop Type 2 changes at the operated level, possibly as a result of accelerated degeneration in the operated disc. Neither the preoperative presence of MCs nor their postoperative course appears to affect the clinical outcome.

Abbreviations used in this paper: MC = Modic change; ODI = Oswestry Disability Index; VAS = visual analog scale.
Article Information

Contributor Notes

Address correspondence to: Nabil Okais, M.D., Department of Neurosurgery, Hôtel-Dieu de France, Ashrafieh, Beirut, Lebanon. email: okais@cyberia.net.lb.
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References
  • 1

    Albert HBManniche C: Modic changes following lumbar disc herniation. Eur Spine J 16:9779822007

  • 2

    Babar SSaifuddin A: MRI of the post-discectomy lumbar spine. Clin Radiol 57:9699812002

  • 3

    Barth MDiepers MWeiss CThomé C: Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 2: radiographic evaluation and correlation with clinical outcome. Spine 33:2732792008

    • Search Google Scholar
    • Export Citation
  • 4

    Barth MWeiss CThomé C: Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 1: evaluation of clinical outcome. Spine 33:2652722008

    • Search Google Scholar
    • Export Citation
  • 5

    Braithwaite IWhite JSaifuddin ARenton PTaylor BA: Vertebral end-plate (Modic) changes on lumbar spine MRI: correlation with pain reproduction at lumbar discography. Eur Spine J 7:3633681998

    • Search Google Scholar
    • Export Citation
  • 6

    Buttermann GRHeithoff KBOgilvie JWTransfeldt EECohen M: Vertebral body MRI related to lumbar fusion results. Eur Spine J 6:1151201997

    • Search Google Scholar
    • Export Citation
  • 7

    Chataigner HOnimus MPolette A: [Surgery for degenerative lumbar disc disease. Should the black disc be grafted?]. Rev Chir Orthop Reparatrice Appar Mot 84:5835891998. (Fr)

    • Search Google Scholar
    • Export Citation
  • 8

    Chin KRTomlinson DTAuerbach JDShatsky JBDeirmengian CA: Success of lumbar microdiscectomy in patients with Modic changes and low-back pain: a prospective pilot study. J Spinal Disord Tech 21:1391442008

    • Search Google Scholar
    • Export Citation
  • 9

    Daltroy LHCats-Baril WLKatz JNFossel AHLiang MH: The North American Spine Society Lumbar Spine Outcome Assessment Instrument: reliability and validity tests. Spine 21:7417491996

    • Search Google Scholar
    • Export Citation
  • 10

    Esposito PPinheiro-Franco JLFroelich SMaitrot D: Predictive value of MRI vertebral end-plate signal changes (Modic) on outcome of surgically treated degenerative disc disease. Results of a cohort study including 60 patients. Neurochirurgie 52:3153222006

    • Search Google Scholar
    • Export Citation
  • 11

    Fairbank JCCouper JDavies JBO'Brien JP: The Oswestry low back pain disability questionnaire. Physiotherapy 66:2712731980

  • 12

    Fairbank JCPynsent PB: The Oswestry Disability Index. Spine 25:294029522000

  • 13

    Fountas KNKapsalaki EZFeltes CHSmisson HF IIIJohnston KWVogel RL: Correlation of the amount of disc removed in a lumbar microdiscectomy with long-term outcome. Spine 29:252125262004

    • Search Google Scholar
    • Export Citation
  • 14

    Jensen TSKarppinen JSorensen JSNiinimäki JLeboeuf-Yde C: Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J 17:140714222008

    • Search Google Scholar
    • Export Citation
  • 15

    Karchevsky MSchweitzer MECarrino JAZoga AMontgomery DParker L: Reactive endplate marrow changes: a systematic morphologic and epidemiologic evaluation. Skeletal Radiol 34:1251292005

    • Search Google Scholar
    • Export Citation
  • 16

    Kirkaldy-Willis WHFarfan HF: Instability of the lumbar spine. Clin Orthop Relat Res 165:1101231982

  • 17

    Kjaer PKorsholm LBendix TSorensen JSLeboeuf-Yde C: Modic changes and their associations with clinical findings. Eur Spine J 15:131213192006

    • Search Google Scholar
    • Export Citation
  • 18

    Kjaer PLeboeuf-Yde CKorsholm LSorensen JSBendix T: Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year-old men and women. Spine 30:117311802005

    • Search Google Scholar
    • Export Citation
  • 19

    Kotilainen E: Long-term outcome of patients suffering from clinical instability after microsurgical treatment of lumbar disc herniation. Acta Neurochir (Wien) 140:1201251998

    • Search Google Scholar
    • Export Citation
  • 20

    Kotilainen EValtonen S: Clinical instability of the lumbar spine after microdiscectomy. Acta Neurochir (Wien) 125:1201261993

  • 21

    Kuisma MKarppinen JNiinimäki JKurunlahti MHaapea MVanharanta H: A three-year follow-up of lumbar spine endplate (Modic) changes. Spine 31:171417182006

    • Search Google Scholar
    • Export Citation
  • 22

    Kuisma MKarppinen JNiinimäki JOjala RHaapea MHeliövaara M: Modic changes in endplates of lumbar vertebral bodies: prevalence and association with low back and sciatic pain among middle-aged male workers. Spine 32:111611222007

    • Search Google Scholar
    • Export Citation
  • 23

    Lang PChafetz NGenant HKMorris JM: Lumbar spinal fusion. Assessment of functional stability with magnetic resonance imaging. Spine 15:5815881990

    • Search Google Scholar
    • Export Citation
  • 24

    Luoma KVehmas TGrönblad MKerttula LKääpä E: MRI follow-up of subchondral signal abnormalities in a selected group of chronic low back pain patients. Eur Spine J 17:130013082008

    • Search Google Scholar
    • Export Citation
  • 25

    Luoma KVehmas TGrönblad MKerttula LKääpä E: Relationship of Modic type 1 change with disc degeneration: a prospective MRI study. Skeletal Radiol 38:2372442009

    • Search Google Scholar
    • Export Citation
  • 26

    McGirt MJAmbrossi GLDatoo GSciubba DMWitham TFWolinsky JP: Recurrent disc herniation and longterm back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal. Neurosurgery 64:3383452009

    • Search Google Scholar
    • Export Citation
  • 27

    Mitra DCassar-Pullicino VNMcCall IW: Longitudinal study of vertebral type-1 end-plate changes on MR of the lumbar spine. Eur Radiol 14:157415812004

    • Search Google Scholar
    • Export Citation
  • 28

    Mochida JNishimura KNomura TToh EChiba M: The importance of preserving disc structure in surgical approaches to lumbar disc herniation. Spine 21:155615641996

    • Search Google Scholar
    • Export Citation
  • 29

    Modic MT: Editorial. Modic Type 1 and Type 2 changes. J Neurosurg Spine 6:1501512007

  • 30

    Modic MTMasaryk TJRoss JSCarter JR: Imaging of degenerative disk disease. Radiology 168:1771861988

  • 31

    Modic MTSteinberg PMRoss JSMasaryk TJCarter JR: Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166:1931991988

    • Search Google Scholar
    • Export Citation
  • 32

    Nizard RSWybier MLaredo JD: Radiologic assessment of lumbar intervertebral instability and degenerative spondylolisthesis. Radiol Clin North Am 39:5571vvi2001

    • Search Google Scholar
    • Export Citation
  • 33

    Rahme RMoussa R: The Modic vertebral endplate and marrow changes: pathologic significance and relation to low back pain and segmental instability of the lumbar spine. AJNR Am J Neuroradiol 29:8388422008

    • Search Google Scholar
    • Export Citation
  • 34

    Ross JSZepp RModic MT: The postoperative lumbar spine: enhanced MR evaluation of the intervertebral disk. AJNR Am J Neuroradiol 17:3233311996

    • Search Google Scholar
    • Export Citation
  • 35

    Schaller B: Failed back surgery syndrome: the role of symptomatic segmental single-level instability after lumbar microdiscectomy. Eur Spine J 13:1931982004

    • Search Google Scholar
    • Export Citation
  • 36

    Schenk PLäubli THodler JKlipstein A: Magnetic resonance imaging of the lumbar spine: findings in female subjects from administrative and nursing professions. Spine 31:270127062006

    • Search Google Scholar
    • Export Citation
  • 37

    Toyone TTakahashi KKitahara HYamagata MMurakami MMoriya H: Vertebral bone-marrow changes in degenerative lumbar disc disease. An MRI study of 74 patients with low back pain. J Bone Joint Surg Br 76:7577641994

    • Search Google Scholar
    • Export Citation
  • 38

    Vital JMGille OPointillart VPedram MBacon PRazanabola F: Course of Modic 1 six months after lumbar posterior osteosynthesis. Spine 28:7157212003

    • Search Google Scholar
    • Export Citation
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