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Modic Change and Clinical Assessment Scores in Patients Undergoing Lumbar Surgery for Disk Herniation
Mark A MacLean1, Nelofar Kureshi1, Jai Shankar2
1Division of Neurosurgery, Dalhousie University.
Study Design:
Retrospective cohort study.
Objective:
To examine the relationship between preoperative Modic change (MC) and postoperative clinical assessment scores for patients receiving lumbar discectomy or transforaminal lumbar interbody fusion for lumbar disk herniation.
Summary Of Background Data:
Lumbar disk herniation is a risk factor for MC development. MC on spinal magnetic resonance imaging (MRI) has been associated with worse preoperative and postoperative clinical assessment scores.
Materials And Methods:
We reviewed data for 285 primary single-level surgeries. Preoperative and 12-month postoperative assessment scores were recorded using the visual analog scale leg pain, Oswestry Disability Index, and Short Form-36 Physical Component Summary. MC subgroup on preoperative MRI was recorded by a single neuroradiologist.
Results:
One hundred seventy-nine patients (female, 56%; age-53±13 y) with preoperative MRI were included. Age and sex were similar across MC subgroups. The sample prevalence of MC on preoperative MRI was 62%, and MC2 was the most common subgroup (35%). No differences in preoperative assessment scores were identified, regardless of presence or absence of MC. For the overall cohort, improvement in assessment scores were observed: Short Form-36 improved an average of 8.2 points [95% CI (95% CI), 5.8-10.7], Oswestry Disability Index by 11.3 points (95% CI, 8.7-14.0), and visual analog scale by 2.8 points (95% CI, 2.1-3.5). In nearly all cases, MCID values were met, even when stratifying by MC subgroup. Few differences in postoperative assessment scores were identified when comparing across MC1, MC2, or no MC groups.
Conclusions:
Statistically and clinically significant improvement in postoperative clinical assessment scores was observed for both lumbar discectomy and transforaminal lumbar interbody fusion groups. MC on preoperative MRI was not associated with worse preoperative or postoperative clinical assessment scores.
Level Of Evidence:
Level III.
Insights
Preoperative Modic changes on MRI did not negatively impact outcomes for patients undergoing lumbar surgery. Both discectomy and fusion procedures led to significant improvements in pain and function, regardless of Modic changes.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Radiology
Background:
- Lumbar disk herniation is a known risk factor for Modic change (MC) development.
- Modic changes (MC) on spinal magnetic resonance imaging (MRI) have been previously associated with poorer clinical outcomes.
- Understanding the impact of preoperative Modic changes on surgical outcomes is crucial for patient management.
Purpose of the Study:
- To investigate the relationship between preoperative Modic changes (MC) and postoperative clinical assessment scores.
- To evaluate the effectiveness of lumbar discectomy and transforaminal lumbar interbody fusion in patients with and without Modic changes.
Main Methods:
- Retrospective cohort study of 285 primary single-level lumbar surgeries.
- Preoperative and 12-month postoperative assessment scores collected using Visual Analog Scale (VAS) for leg pain, Oswestry Disability Index (ODI), and Short Form-36 Physical Component Summary (SF-36 PCS).
- Modic change (MC) status on preoperative MRI was determined by a single neuroradiologist.
Main Results:
- Prevalence of Modic change (MC) on preoperative MRI was 62%, with MC2 being the most common subtype (35%).
- No significant differences in preoperative assessment scores were observed between patients with or without Modic changes.
- Overall cohort showed significant improvements in SF-36 PCS, ODI, and VAS scores postoperatively, with most patients meeting MCID thresholds.
- Few differences in postoperative scores were noted across MC subgroups (MC1, MC2, no MC).
Conclusions:
- Lumbar discectomy and transforaminal lumbar interbody fusion yield statistically and clinically significant improvements in postoperative outcomes.
- Preoperative Modic changes on MRI are not associated with worse preoperative or postoperative clinical assessment scores.
- Modic changes do not appear to negatively influence surgical outcomes for lumbar disk herniation.
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