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Evaluating the Impact of Modic Changes on Operative Treatment in the Cervical and Lumbar Spine: A Systematic Review
Mark J Lambrechts1, Parker Brush1, Tariq Z Issa1
1Rothman Orthopedic Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Abstract:
Modic changes (MCs) are believed to be potential pain generators in the lumbar and cervical spine, but it is currently unclear if their presence affects postsurgical outcomes. We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies evaluating cervical or lumbar spine postsurgical outcomes in patients with documented preoperative MCs were included. A total of 29 studies and 6013 patients with 2688 of those patients having preoperative MCs were included. Eight included studies evaluated cervical spine surgery, eleven evaluated lumbar discectomies, nine studied lumbar fusion surgery, and three assessed lumbar disc replacements. The presence of cervical MCs did not impact the clinical outcomes in the cervical spine procedures. Moreover, most studies found that MCs did not significantly impact the clinical outcomes following lumbar fusion, lumbar discectomy, or lumbar disc replacement. A meta-analysis of the relevant data found no significant association between MCs and VAS back pain or ODI following lumbar discectomy. Similarly, there was no association between MCs and JOA or neck pain following ACDF procedures. Patients with MC experienced statistically significant improvements following lumbar or cervical spine surgery. The postoperative improvements were similar to patients without MCs in the cervical and lumbar spine.
Insights
Modic changes (MCs) in the spine do not appear to negatively impact surgical outcomes. Patients with MCs experienced similar improvements after cervical and lumbar spine surgery compared to those without MCs.
Area of Science:
- Spine Surgery
- Radiology
- Clinical Outcomes
Background:
- Modic changes (MCs) are common findings on spinal MRI.
- MCs are suspected pain generators, but their impact on postsurgical outcomes remains unclear.
Purpose of the Study:
- To systematically review the literature on the effect of preoperative Modic changes on postsurgical outcomes in cervical and lumbar spine procedures.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Inclusion of studies evaluating cervical or lumbar spine surgery outcomes in patients with preoperative MCs.
- Meta-analysis of relevant data for specific outcomes like VAS and ODI.
Main Results:
- Presence of cervical MCs did not impact clinical outcomes in cervical spine surgeries.
- Most studies indicated MCs did not significantly affect outcomes after lumbar fusion, discectomy, or disc replacement.
- Meta-analysis found no significant association between MCs and pain/disability scores (VAS, ODI, JOA) post-lumbar discectomy or ACDF.
- Patients with MCs showed significant postoperative improvement, comparable to those without MCs.
Conclusions:
- Preoperative Modic changes do not appear to adversely affect clinical outcomes following cervical or lumbar spine surgery.
- Patients with Modic changes achieve similar functional improvements post-surgery as patients without these changes.
