Application of oblique lateral interbody fusion in the treatment of lumbar intervertebral disc degeneration in patients with Modic change and endplate sclerosis / 中国骨伤

OBJECTIVE@#To explore the feasibility and clinical effect of Stand-alone oblique lateral interbody fusion (OLIF) in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis.@*METHODS@#A retrospective analysis was performed on 16 cases with lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis admitted to three medical centers from January 2015 to December 2018. There were 6 males and 10 females, the age ranged from 45 to 67 years old with an average of (55.48±8.07) years old, the medical history ranged from 36 to 240 months with an average of (82.40±47.68) months. The lesion sites included L2,3 in 2 cases, L3,4 in 5 cases, and L4,5 in 9 cases. All patients presented with chronic low back pain with lower limb neurological symptoms in 3 cases. All patients were treated by Stand-alone oblique lateral lumbar interbody fusion. Clinical and radiological findings and complications were observed.@*RESULTS@#There was no vascular injury, endplate injury and vertebral fracture during the operation. The mean incision length, operation time, and intraoperative blood loss were(4.06±0.42) cm, (45.12±5.43) min, (33.40±7.29) ml, respectively. The mean visual analogue scale (VAS) of the incision pain was (1.14±0.47) at 72 hours after operation. There was no incision skin necrosis, poor incision healing or infection in patients. Sympathetic chain injury occurred in 1 case, anterolateral pain and numbness of the left thigh in 2 cases, and weakness of the left iliopsoas muscle in 1 case, all of which were transient injuries with a complication rate of 25%(4/16). All 16 patients were followed up from 12 to 36 months with an average of (20.80±5.46) months. The intervertebral space height was significantly recovered after operation, with slight lost during the follow-up. Coronal and sagittal balance of the lumbar spine showed good improvement at the final follow-up. There was no obvious subsidence or displacement of the cage, and the interbody fusion was obtained. At the final follow-up, Japanese Orthopaedic Association(JOA) score and Oswestry disability index(ODI) were significantly improved.@*CONCLUSION@#As long as the selection of case is strict enough and the preoperative examination is sufficients, the use of Stand-alone OLIF in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis has a good results, with obvious clinical advantages and is a better surgical choice.

Research progress on the influence of Modic changes on lumbar interbody fusion and its treatment measure / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of Modic changes and its influence on lumbar interbody fusion.@*METHODS@#The domestic and foreign literature related to Modic changes and its influence on lumbar interbody fusion was extensively reviewed. The etiology of Modic changes was summarized, and the treatment measures of Modic changes on lumbar interbody fusion were discussed.@*RESULTS@#The etiology of Modic changes is not clear, which may be related to mechanical factors, autoimmune factors, low toxic infection factors, and genetic factors. Modic changes may lead to fusion failure and cage subsidence after lumbar interbody fusion. Preoperative evaluation of endplate sclerosis, reduction of iatrogenic endplate injury, fine operating of intervertebral space, management of osteoporosis, and selection of appropriate cage can prevent or reduce fusion failure or cage subsidence.@*CONCLUSION@#Modic changes may lead to fusion failure and cage subsidence after lumbar interbody fusion, and active perioperative intervention of Modic changes is helpful to improve the clinical prognosis.

Prevalence, Patterns, and Genetic Association Analysis of Modic Vertebral Endplate Changes

STUDY DESIGN: A prospective genetic association study. PURPOSE: The etiology of Modic changes (MCs) is unclear. Recently, the role of genetic factors in the etiology of MCs has been evaluated. However, studies with a larger patient subset are lacking, and candidate genes involved in other disc degeneration phenotypes have not been evaluated. We studied the prevalence of MCs and genetic association of 41 candidate genes in a large Indian cohort. OVERVIEW OF LITERATURE: MCs are vertebral endplate signal changes predominantly observed in the lumbar spine. A significant association between MCs and lumbar disc degeneration and nonspecific low back pain has been described, with the etiopathogenesis implicating various mechanical, infective, and biochemical factors. METHODS: We studied 809 patients using 1.5-T magnetic resonance imaging to determine the prevalence, patterns, distribution, and type of lumbar MCs. Genetic association analysis of 71 single nucleotide polymorphisms (SNPs) of 41 candidate genes was performed based on the presence or absence of MCs. SNPs were genotyped using the Sequenome platform, and an association test was performed using PLINK software. RESULTS: The mean age of the study population (n=809) was 36.7±10.8 years. Based on the presence of MCs, the cohort was divided into 702 controls and 107 cases (prevalence, 13%). MCs were more commonly present in the lower (149/251, 59.4%) than in the upper (102/251, 40.6%) endplates. L4–5 endplates were the most commonly affected levels (30.7%). Type 2 MCs were the most commonly observed pattern (n=206, 82%). The rs2228570 SNP of VDR (p=0.02) and rs17099008 SNP of MMP20 (p=0.03) were significantly associated with MCs. CONCLUSIONS: Genetic polymorphisms of SNPs of VDR and MMP20 were significantly associated with MCs. Understanding the etiopathogenetic mechanisms of MCs is important for planning preventive and therapeutic strategies.

A comparative study of radiographic lumbar Modic changes / 实用放射学杂志

Objective To analyze the imaging performances and significance of Modic changes on X-ray,CT and MRI.Methods The imaging data (MR,CT and X-ray)of patients with low back pain were retrospectively analyzed.The selected patients’images were studied on the same work station by the two physician experts in muscle and bone imaging.A double-blind method was used. Firstly,MRI was used to sort the MC.Then,the alterations of the density in the lesions on X-ray plain film and CT image were measured.if the judgments of the two readers were inconsistent,another professor of radiology will join the discussion and consist-ent results will be got finally.The data were recorded using Excel 2010,and processed for statistical analysis using SPSS 1 6.0.Re-sults A total of 47 cases that met the requirements were collected which included 1 6 males and 31 females,aged from 32 to 76 years,with a median age of 56.0 years.A total of 93 on MRI endplate were changed.However,a part of lumbar endplates with MC on MRI images were displayed as higher density than normal vertebral body on the X-ray and CT reconstruction images (total of 36).The occurrence rates of Type Ⅰ,Type Ⅱ,Type Ⅰ/Ⅱ were 40.0%,14.8%,58.3%,respectively.But the occurrence rate of Type Ⅲ (100%)and hybrid Type which contained type Ⅲ were 100%.Conclusion Some Modic typeⅠ,Ⅱ,Ⅰ/Ⅱchanges in X-ray plain film, CT reconstruction images had a higher density,speculating that there is reactive new bone formation,which reflects the internal ver-tebral body bone mineralized rather than the change of the bone marrow.

Correlation of Vertebral Bone Mineral Density and Modic Changes in Menopausal Females with Chronic Low Back Pain / 中国医学影像学杂志

PurposeIt has been reported that women have higher incidence of Modic changes than men and it may be related to the change of female hormone levels during menopause which leads to osteoporosis and other factors. This paper investigated the relationship between vertebral bone mineral density (BMD) of menopausal female suffering from chronic low pain and lumbar vertebral Modic changes on MRI, to explore the effect of vertebral bone mineral density upon Modic changes.Materials and Methods A total of 205 menopausal women with chronic low back pain were enrolled and underwent vertebral bone mineral density measurement and lumbar MRI examination. The bone mass of vertebral body and bone imaging data were observed. All patients were divided into three groups according to their level of bone mass: group of normal bone mass: 128 cases; osteopenia group: 58 cases; osteoporosis group: 19 cases. The incidence rate of Modic changes was compared among the three groups and the relationship between bone mineral density and vertebral Modic changes was further analyzed.Results Among 205 patients, 128 were with normal bone mass, 44 had Modic changes (type I: 19 cases; type II: 22 cases; type III: 3 cases) and the incidence rate was 34.4%; osteopenia occurred in 58 patients, among whom 34 had Modic changes (type I: 15 cases; type II: 17 cases; type III: 2 cases), which showed that the rate was 58.6%; 19 patients presented osteoporosis, 15 of whom appeared Modic changes (type I: 6 cases, type II: 7 cases;type III: 2 cases), with the rate of 78.9%. There was statistically signiifcant difference in incidence rate of Modic changes among the three groups (χ2=18.995,P0.05).Conclusion Lumbar vertebral bone mineral density is correlated to the incidence of vertebral Modic changes in menopausal women with chronic low back pain. With the loss of vertebral bone mass, the incidence of vertebral Modic changes gradually rise. However, the correlation is rather weak; Modic change is a dynamic process, which is also influenced by other factors except vertebral bone mineral density.

MRI Evaluation of Disc Lesions Causing Lumbar Canal Stenosis and Backache

Degenerative disease of the lumbar spine refers to a syndrome in which an intervertebral disc with adjacent spine structures is compromised, this can be due to aging process associated with pathology. Thirty five percent of asymptomatic individuals may have degenerative spine findings, including: disc degeneration, modic changes, disc bulges, facet joint arthropathy and spinal stenosis. Plain radiography provides only limited diagnostic information. It cannot show the structural morphology of the intervertebral disc. Magnetic resonance imaging (MRI) is helpful in detecting changes like disc displacement (bulge, protrusion, extrusion, sequestration), OPLL, zygapophyseal joint hypertrophy, buckling or hypertrophy of ligaments. Also MRI is helpful in differentiating central canal stenosis from lateral canal stenosis. Study population included all patients above 20 years of age with LBP with/without radiculopathy who were referred for lumbar spine MRI at Radiology Department, SRMCH from August 2011 to September 2013. All consented patients with LBP with/without radiculopathy referred for lumbar MRI were consecutively included in the study. A total of 280 individuals had lumbar MRI scan from August 2011 to September 2013, but only 250 whom fulfilled the study criterion were studied.

Analysis of the effect of surgical treatment of low back pain patients with Modic change or high intensity zone on MRI of the lumbar spine / 重庆医学

Objective To explore the effect of surgical treatment of low back pain patients with Modic change or high intensity zone(HIZ) on MRI of the lumbar spine .Methods 32 cases with intervertebral disc herniation underwent posterior lumbar inter-body fusion and 17 cases with lumbar discogenic pain underwent radiofrequency ablation from March 2011 to July 2012 were retro-spectively reviewed .For intervertebral disc herniation patients ,all patients were divided into two groups :groupⅠ (no with Modic changes group)and groupⅡ(with Modic changes group) ,according to the Admission MRI .GroupⅡ was sub-divided intoⅡa(Mod-ic type Ⅰgroup) andⅡb(Modic type Ⅱgroup) .For lumbar discogenic pain patients ,all patients were divided into group A (without HIZ group) and group B(with HIZ group) .The VAS and ODI scales at the preoperative and follow-up were recorded and analyzed . Results The postoperative scores of VAS and ODI of all the patients were improved ,and the difference was statistically significant (P0 .05) .For lum-bar discogenic pain patients ,the improvement rate of VAS (low backpain) of A was better than that of B ,and the difference was sta-tistically significant(P0 .05) . Conclusion Posterior lumbar interbody fusion is effective for lumbar disc herniation patients with Modic changes ,and can obtain good clinical effect .For lumbar discogenic pain patients with high intensity zone on MRI ,radiofrequency ablation can cause clinical symptoms get some relief ,but the effect is poor .

Should We Start Treating Chronic Low Back Pain with Antibiotics Rather than with Pain Medications?

For those of us who have read the 2 recently published articles by a Danish - British research group, it might appear that we are observing an impending paradigm shift on the origins of chronic low back pain. The results of this research indicate, that chronic low back pain associated with bone marrow edema in vertebral endplates that are adjacent to herniated intervertebral discs may be caused by infections with anaerobic bacteria of low virulence. According to these articles, treatment with certain antibiotics is significantly more effective than placebo against this low back pain. If these findings are to hold true in repeat studies by other researchers, they stand to fundamentally change our concepts of low back pain, degenerative disc disease and in consequence the suitable therapies for these entities. It may in fact require pain specialists to become familiarized with the details of antibiotic treatments and their specific risks in order to be able to properly counsel their patients. While this seems hard to believe at first glance, bacteria have been implicated in the pathogenesis of other conditions that do not primarily impose as infectious diseases such as gastric ulcers. While the authors refer to a few previous studies pointing into the same direction, the relevant research is really only from one group of collaborating scientists. Therefore, before we start prescribing antibiotics for chronic low back pain, it is imperative that other researchers in different institutions confirm these results.

Relationship of Modic changes in endplates of cervical vertebral body with axial pain / 第二军医大学学报

Objective: To investigate the prevalence and clinical significance of Modic changes in endplates of cervical vertebral body in patients with cervical spondylotic myelopathy(CSM). Methods: The T1-weight and T2-weight sagittal MRI scans of 136 CSM patients undergoing anterior operation were retrospectively reviewed. The patients' age, gender, prevalence, precise vertebral levels and specific type of Modic changes were recorded, and the association of axial pain with Modic changes was analyzed. Results: Modic changes were observed in 23 patients (16.9%), including 17(17.7%) male and 6(15%) female. The most frequent cervical spinal levels of Modic changes was C5-6. Of all the patients, 4.4% had type I Modic change, 7.4% had type II, and 5.1% had type III. The incidence of axial pain was 56.5% in Modic change groups and 20.4% in non-Modic change groups; there was significant difference between the two groups (P0.05). The pre-operation incidences of axial pain in patients with type I, type II and type III Modic change were 83.3%, 60% and 28.6%, respectively; and the post-operation pain-relieving rates were 100%, 66.7% and 50%, respectively. Conclusion: The most common Modic change is type II in the cervical spine, with the C5-6 level being the most frequently involved. The incidence of axial pain is high in patients with Modic change, especially those with type I.

Effects of Modic II changes on clinical outcomes of discectomy / 中国医师进修杂志

Objective To discuss the effects of Modic II changes on clinical outcomes of discectomy for lumbar disc herniation (LDH) with low back pain associated with unilateral sciatica. Methods Sixty-five cases of LDH with low back pain associated with unilateral sciatica received single segment discectomy during January 2007 to January 2009.There were 30 cases with Modic Ⅱ changes in group A, 35 cases without Modic Ⅱ changes in group B. Assessed the clinical outcomes by using MacNab analyzing system and visual analog scale (VAS). Results Two groups of the postoperative clinical symptoms had significant relief, the follow-up of 12 - 36 months, average (20.6 ± 7.5) months. MacNab efficacy evaluation by group A of optimal 10 cases (33.33%), good 17 cases (56.67%), general 3 cases (10.00%). Group B optimal 28 cases (80.00%), good 5 cases (14.29%), general 2 cases (5.71%), there was significant difference in fine rate (P<0.05). Preoperative group A VAS was ( 8.67 ± 0.30) scores, group B was (8.60± 0.32 ) scores (P>0.05). Postoperative group A VAS was (2.63 ± 1.30) scores,group B was (1.09 ±0.50) scores (P< 0.05). Conclusion Modic Ⅱ changes may be one of the reasons which cause the residual low back pain after the discectomy for LDH.