Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation With Type II Modic Changes

Area of Science:

• Spine surgery
• Minimally invasive procedures
• Degenerative disc disease

Background:

• Lumbar radiculopathy due to intervertebral disc herniation is commonly treated with PELD.
• Type II Modic changes are associated with persistent low back pain and increased LDH recurrence after surgery.
• Evaluating PELD outcomes in LDH patients with type II Modic changes is crucial.

Purpose of the Study:

• To assess the efficacy of PELD in managing lumbar disc herniation (LDH) patients with type II Modic changes.
• To compare clinical outcomes and recurrence rates between LDH patients with and without type II Modic changes after PELD.
• To identify potential challenges and suggest management strategies for LDH patients with type II Modic changes undergoing PELD.

Main Methods:

• A cohort of 267 single-level LDH patients (aged 20-50) who underwent PELD was analyzed.
• Clinical outcomes including VAS, ODI, and MacNab scores were evaluated pre- and post-surgery up to 48 months.
• Comparison of outcomes between patients with and without type II Modic changes was performed.

Main Results:

• PELD significantly improved VAS and ODI scores in all analyzed LDH patients.
• Excellent/good MacNab scores were achieved in 87.0% (non-Modic) and 82.1% (Modic type II) of patients.
• LDH patients with type II Modic changes showed higher VAS/ODI scores and recurrence rates at longer follow-up.

Conclusions:

• PELD is an effective treatment for LDH, but careful consideration is needed for patients with type II Modic changes.
• Continuous low back pain and recurrence risk are elevated in LDH patients with type II Modic changes post-PELD.
• Extended brace support or alternative interventions may benefit LDH patients with type II Modic changes.