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Pear-Shaped Disc as a Risk Factor for Postoperative Sclerotic Modic Changes After Transforaminal Lumbar Interbody
Yang Xiao1, Wenbin Shuai2, Zhuang Zhang1
1Department of Orthopaedic, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Orthopaedic Surgery
|January 8, 2025
Summary
Pear-shaped discs and higher body mass index (BMI) are independent risk factors for postoperative sclerotic Modic Changes (MCs) after spinal fusion. These changes are associated with lower fusion rates and poorer outcomes.
Area of Science:
- Spine surgery
- Radiology
- Orthopedics
Background:
- Pear-shaped discs may increase the risk of end-plate injury during spinal fusion.
- Postoperative sclerotic Modic Changes (MCs) can arise from end-plate injury.
- The relationship between pear-shaped discs and postoperative sclerotic MCs is not well-established.
Purpose of the Study:
- To investigate risk factors for postoperative sclerotic MCs following transforaminal lumbar interbody fusion (TLIF).
- To specifically assess the impact of pear-shaped discs on the occurrence of postoperative sclerotic MCs.
- To evaluate the influence of pear-shaped discs and associated factors on clinical outcomes after TLIF.
Main Methods:
- Retrospective analysis of 411 patients undergoing TLIF (January 2018 - January 2022).
- Matched case-control study comparing 50 patients with postoperative sclerotic MCs to 50 without.
- Evaluations included VAS, ODI, X-ray, CT, MRI; statistical analysis used t-tests, chi-square, and logistic regression.
Main Results:
- A significantly higher prevalence of pear-shaped discs (27 vs. 7) was observed in the postoperative sclerotic MCs group.
- Independent risk factors for postoperative sclerotic MCs included pear-shaped disc and higher BMI.
- Patients with sclerotic MCs showed lower fusion rates, increased cage subsidence, and poorer outcomes.
Conclusions:
- Pear-shaped disc morphology and elevated BMI are significant independent risk factors for developing postoperative sclerotic MCs after TLIF.
- Postoperative sclerotic MCs are associated with diminished spinal fusion, increased cage subsidence, and less favorable clinical symptom improvement.
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