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Updated: Jan 3, 2026
Full-Endoscopic Transforaminal Approach for Lumbar Discectomy
Published on: September 8, 2023
Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation with Modic Changes via a Transforaminal
Jietao Xu1, Yawei Li1, Bing Wang1
1Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Background:
The surgical selection for patients with lumbar disc herniation (LDH) with Modic changes (MCs) is still contentious. Percutaneous endoscopic lumbar discectomy via a transforaminal approach (TF-PELD) as a representative minimally invasive spine surgery technique for LDH has been standardized. However, its efficacy has not been thoroughly described in the patients with LDH with MCs.
Objectives:
The goal of this study was to assess the clinical outcomes of TF-PELD in the treatment of LDH and MCs.
Study Design:
Retrospective study.
Setting:
Inpatient surgery center.
Methods:
From January 2015 to December 2016, 276 patients with LDH showing normal or MCs signals in their bone marrow in our hospital were enrolled in this retrospective study. All patients suffered low back and leg pain because of LDH and underwent the TF-PELD procedure. Clinical outcomes were assessed according to the Visual Analog Scale (VAS) for back pain and leg pain, Oswestry Disability Index (ODI) for functional status assessment, and modified MacNab criteria for patient satisfaction.
Results:
A total of 182 patients showed normal intensity, 44 patients showed Modic type 1 signals, and 50 patients showed Modic type 2 signals before surgery. The postoperative VAS and ODI scores were significantly improved compared with those preoperatively among the groups. In the Modic type 1 and 2 signals groups, however, the postoperative VAS scores for back pain and ODI scores showed an upward trend with the follow-up time extending. The recurrence rates were 4.4%, 9.1%, and 8.0% in the normal, Modic type 1 and 2 signals groups, respectively. The recurrence rates and satisfaction rates showed no significant difference among the groups at the final follow-up.
Limitations:
This study has a small sample size and the follow-up period was too short. There is no comparison with other therapeutic options such as fusion surgery or the lack of any other treatment.
Conclusions:
TF-PELD is an option for treatment of patients with LDH even if the patients show MCs. However, the postoperative back pain and functional status have the trend of deterioration with the time extending in patients with MCs, especially in the Modic type 1 signals.
Key Words:
Modic changes, Modic type 1, Modic type 2, transforaminal percutaneous endoscopic lumbar discectomy, lumbar disc herniation, back pain, recurrence, complication.
Insights
Transforaminal percutaneous endoscopic lumbar discectomy (TF-PELD) is a viable option for lumbar disc herniation (LDH) with Modic changes (MCs). However, patients with MCs, particularly Modic type 1, may experience worsening back pain and function over time.
Area of Science:
- Spine surgery
- Minimally invasive procedures
- Degenerative disc disease
Background:
- Surgical selection for lumbar disc herniation (LDH) with Modic changes (MCs) remains debated.
- Transforaminal percutaneous endoscopic lumbar discectomy (TF-PELD) is a standardized minimally invasive technique for LDH.
- The efficacy of TF-PELD in patients with LDH and MCs requires further investigation.
Purpose of the Study:
- To evaluate the clinical outcomes of TF-PELD in patients with LDH and MCs.
- To assess the impact of Modic changes on surgical results.
- To analyze patient satisfaction and recurrence rates after TF-PELD.
Main Methods:
- Retrospective study of 276 patients with LDH from January 2015 to December 2016.
- Patients underwent TF-PELD for low back and leg pain.
- Outcomes measured by Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria.
Main Results:
- Significant improvements in postoperative VAS and ODI scores were observed across all groups (normal, Modic type 1, Modic type 2).
- Patients with Modic type 1 and 2 changes showed a trend of increasing back pain (VAS) and functional disability (ODI) over time.
- Recurrence rates were 4.4% (normal), 9.1% (Modic type 1), and 8.0% (Modic type 2), with no significant difference in satisfaction.
Conclusions:
- TF-PELD is a feasible treatment option for LDH patients with MCs.
- Long-term outcomes may show deterioration in back pain and function for MCs patients, especially Modic type 1.
- Further research with longer follow-up and comparative analyses is warranted.
