Related Experiment Video
Updated: Dec 21, 2025
Full-Endoscopic Transforaminal Approach for Lumbar Discectomy
Published on: September 8, 2023
Recurrent disc herniation following percutaneous endoscopic lumbar discectomy preferentially occurs when Modic
Lu Hao1, Shengwen Li2, Junhui Liu1
1Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Zhejiang University, No. 3, Qingchun Road East, Hangzhou, 310016, People's Republic of China.
Objective:
To investigate the relationship between Modic changes (MCs) and recurrent lumbar disc herniation (rLDH) and that between the herniated disc component and rLDH following percutaneous endoscopic lumbar discectomy (PELD).
Methods:
We included 102 (65 males, 37 females, aged 20-66 years) inpatients who underwent PELD from August 2013 to August 2016. All patients underwent CT and MRI preoperatively. The presence and type of Modic changes were assessed. During surgery, the herniated disc component of each patient was classified into two groups: nucleus pulposus group and hyaline cartilage group. The association of herniated disc component with Modic changes was investigated. The incidence of rLDH was assessed based on a more than 2-year follow-up.
Results:
In total, 11 patients were lost to follow-up; the other 91 were followed up during 24-60 months. Of the 91 patients, 99 discs underwent PELD; 28/99 (28.3%) had MCs. Type I and II MCs were seen in 9 (9.1%) and 19 (19.2%), respectively; no type III MCs were found. Among 28 endplates with MCs, according to the herniated disc component, 18/28 (64.3%) showed evidence of hyaline cartilage in the intraoperative specimens, including 6/9 and 12/19 endplates with type I and II MCs, respectively. Among 71 endplates without MCs, 14/71 (19.7%) showed evidence of hyaline cartilage in the intraoperative specimens. Hyaline cartilage was more common in patients with MCs (P < 0.05). We found 2 cases of rLDH in the non-MC group (n = 71); 6 cases of rLDH were found in the MC group (n = 28), including 2 and 4 cases for types I and II, respectively. There was no significant difference between types I and II (P > 0.05). rLDH was more common in patients with MCs (P < 0.05). We found 5 rLDH cases in the hyaline cartilage group (n = 32); 3 rLDH cases were found in the nucleus pulposus group (n = 67). rLDH was more common in the hyaline cartilage group (P < 0.05).
Conclusions:
rLDH following PELD preferentially occurs when MCs or herniated cartilage are present.
Insights
Recurrent lumbar disc herniation (rLDH) after percutaneous endoscopic lumbar discectomy (PELD) is more common in patients with Modic changes (MCs) or herniated cartilage. These findings highlight key factors influencing rLDH risk post-PELD.
Area of Science:
- Spine surgery
- Degenerative disc disease
- Radiology
Background:
- Modic changes (MCs) are common findings on MRI of the lumbar spine, often associated with disc degeneration.
- Recurrent lumbar disc herniation (rLDH) is a significant complication following surgical interventions like percutaneous endoscopic lumbar discectomy (PELD).
- Understanding predictors of rLDH is crucial for improving patient outcomes after PELD.
Purpose of the Study:
- To investigate the association between Modic changes (MCs) and recurrent lumbar disc herniation (rLDH) after PELD.
- To examine the relationship between the type of herniated disc component and the incidence of rLDH post-PELD.
Main Methods:
- A cohort of 102 patients undergoing PELD were assessed preoperatively using CT and MRI for Modic changes.
- Herniated disc components were intraoperatively classified into nucleus pulposus or hyaline cartilage groups.
- Patients were followed for over 2 years to determine the incidence of rLDH.
Main Results:
- Modic changes were present in 28.3% of the 99 discs treated with PELD, with Types I and II being most common.
- Hyaline cartilage was significantly more prevalent in discs with MCs compared to those without (64.3% vs 19.7%).
- rLDH occurred more frequently in patients with MCs (6/28) and the hyaline cartilage group (5/32) compared to their respective counterparts.
Conclusions:
- The presence of Modic changes and herniated cartilage are significant risk factors for recurrent lumbar disc herniation following PELD.
- These findings suggest that preoperative identification of MCs and intraoperative assessment of disc tissue may help predict rLDH risk.
