Do Modic changes have an impact on clinical outcome in lumbar spine surgery? A systematic literature review

Aske Foldbjerg Laustsen, Rachid Bech-Azeddine

October 2016, Volume 25, Issue 11, pp 3735 - 3745 Review Article Read Full Article

First Online: 13 May 2016

Purpose

To provide a systematic literature review of the impact of preoperative Modic changes (MCs) on the clinical outcome following lumbar spine surgery for degenerative lumbar spine disease.

Methods

A PubMed search until 31 October 2015 was performed to identify publications correlating preoperative MC with clinical outcome in patients undergoing spine surgery.

Results

Inclusion criteria were met by 14 articles (7 prospective and 7 retrospective studies) representing a total of 1652 surgical patients, of which at least 804 (>49 %) showed MC. Of the 14 publications, 6 concerned discectomy (n = 607), 1 fusion versus discectomy (n = 91), 3 fusion surgery (n = 454), and 4 total disc replacement (TDR, n = 500). A trend toward less improvement in low back pain or Oswestry Disability Index score was found in the discectomy studies, and a trend toward increased improvement was demonstrated in the TDR studies when MC was present preoperatively. The fusion studies were of low evidence, and showed conflicting results.

Conclusion

Preoperative MC showed a trend toward a negative correlation with clinical improvement in patients undergoing discectomy for LDH and a positive correlation with clinical improvement in patients undergoing TDR for degenerative disc disease. However, it is questionable whether the differences surpass the minimal clinically important difference (MCID). In patients undergoing fusion surgery, there was insufficient evidence to draw any conclusions. Future studies should include a larger patient material, focus on MCID, and include known confounding factors of the clinical outcome of spine surgery in the analysis.

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