Effect of Preoperative Modic Changes on the Outcome of Patients with Lumbar Degenerative Disc Disease Following Posterior Spinal Fusion or Laminectomy

Document Type : Original Article


The Department of Neurosurgery, Faculty of Medicine, Cairo* and Beni-Suef** Universities


Abstract Background: Various MC types have been reported to have an impact on the surgical outcome in LBP patients. Magnetic resonance imaging (MRI) findings of Modic changes (MC) are linked to persistent low back pain (LBP). Different MC types may have an impact on how well individuals with LBP respond to surgery. Aim of Study: The objective of the study is to assess the impact of preoperative Modic changes (MC) on the prognosis of patients suffering from low back pain (LBP) resulting from degenerative disc disease after posterior spinal fusion (PSF) with laminectomy or laminectomy alone.
Methods: This prospective study was conducted upon 30 patients at Cairo University Hospitals and Beni-Suef universi-ty hospital starting in March 2020 to be completed in October 2020. We assessed the outcome at 30 patients with LBP and MC Type I and II who had laminectomy (n=15) or PSF (n=15). MC types were determined using preoperative MRI. The pain intensity was measured using visual analogue scale (VAS) be-fore and three months after surgery. Results: The study was conducted upon 30 Patients be-tween 30 to 65 years old with a mean 45.5. 17 were males and 13 were females. Low back pain was the most prevalent pre-senting symptom across all participants, followed by claudica-tion pain in 83.3%. Preoperative to postoperative (VAS) chang-es were documented in our study. Regarding the type I Modic changes, Pain VAS improved immediately post- operative after both laminectomy only (group A) and laminectomy with PSF (group B) with mean ± SD 3.5 and 2.29 points for group A, B respectively. While Pain VAS 3 months post-operative, patients who underwent management in group B improved more than whose who underwent management in group A with mean ± SD 1.14±0.69 which is statistically significant with p-value=0.008. Regarding type II Modic changes, Pain VAS improved immedi-ate post-operative and 3 months post-operative in both groups with no significant difference in values. Conclusion: Patients with LBP who also have MC benefit greatly from surgical treatment in terms of reduced pain. For patients with MC Type I, PSF appears to be a more effective treatment.