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Updated: May 5, 2026
Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
Do modic changes affect the fusion rate in spinal interbody fusion surgery? A systematic review and network
Rigao Chen1, Kai Zou1, Jianjia Liu1
1Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China.
Objective:
To compare the fusion rates of spinal interbody fusion in patients with modic changes (MCs).
Methods:
This meta-analysis was registered at PROSPERO, and the project number was CRD42024538023. This network meta-analysis was conducted according to the PRISMA 2020 statement. The PubMed, Embase, Web of Science Core Collection, ClinicalTrials.gov and Cochrane Library databases were searched from inception to March 28, 2024 for potential studies. STATA 13.0 and Review Manager 5.3 were used to perform the meta-analysis.
Results:
Seven studies with a total of 1162 patients or segments assigned to four groups according to MCs grade were identified. The fusion rate in the non-modic changes (NMCs) was significantly greater than that in the MCs at the 3-month (p = 0.0001) and 6-month (p = 0.002) follow-ups. No significant difference was detected in the fusion rate at 12-month (p = 0.34) and final follow-ups (p = 0.41). No significant difference was found in cervical fusion (p = 0.88) or transforaminal lumbar interbody fusion (TLIF) (p = 0.51). The fusion rate of NMCs was significantly greater than that of MCs in posterior lumbar interbody fusion (PLIF) (p < 0.00001). No significant differences were identified among the four groups in the overall comparison, cervical fusion or TLIF subgroups. The fusion rate in the NMCs was significantly greater than that in the MCs-2 and MCs-3 in the PLIF.
Conclusion:
MCs decreased the fusion rate at the 3- and 6-month follow-ups. MCs-2 and MCs-3 decrease the fusion rate in PLIF.
Insights
Modic changes (MCs) in spinal interbody fusion initially reduce fusion rates at 3 and 6 months. However, these differences diminish over time, with specific grades (MCs-2 and MCs-3) impacting posterior lumbar interbody fusion outcomes.
Area of Science:
- Spine Surgery
- Orthopedics
- Radiology
Background:
- Modic changes (MCs) are common findings on spinal MRI.
- Their impact on spinal interbody fusion rates is not fully understood.
- Understanding MCs' effect is crucial for surgical planning and patient outcomes.
Purpose of the Study:
- To compare spinal interbody fusion rates in patients with and without Modic changes (MCs).
- To analyze the influence of different grades of MCs on fusion success.
- To evaluate fusion rates across various surgical techniques and time points.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Embase, Web of Science, ClinicalTrials.gov, Cochrane Library).
- A network meta-analysis was performed according to PRISMA 2020 guidelines.
- Statistical analysis was done using STATA 13.0 and Review Manager 5.3.
Main Results:
- Seven studies involving 1162 patients were analyzed.
- Fusion rates were significantly lower in patients with MCs at 3 and 6 months compared to non-MCs.
- No significant differences were observed at 12 months or final follow-up; however, MCs negatively impacted posterior lumbar interbody fusion (PLIF) rates, particularly MCs-2 and MCs-3.
Conclusions:
- Modic changes (MCs) are associated with reduced spinal fusion rates in the early postoperative period (3 and 6 months).
- Specific Modic change grades (MCs-2 and MCs-3) negatively affect fusion rates in posterior lumbar interbody fusion (PLIF).
- The long-term impact of MCs on overall fusion rates appears minimal, but technique-specific effects warrant attention.
