The Effect of Fusion Added to Lumbar Discectomy in Patients with Modic Changes: A Retrospective Comparative Outcome Analysis Regarding Back Pain Control

Background Data: In 1988, Modic et al first described magnetic resonance (MR) degenerative changes in the lumbar vertebral bodies. changes in the intervertebral endplates, Modic Changes (MC) can also be incriminated in the production of such pain due to the mechanical failure and structural changes...

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Autores principales:	Ahmad Elsayed Desoukey Elayouty, MD., Walid Ahmed Abdel Ghany, MD.
Formato:	article
Lenguaje:	EN
Publicado:	Egyptian Spine Association 2018
Materias:	Modic changes lumbar discectomy low back pain Lumbar fusion Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/3d755b96afba4023bfee83be1ec7df9d
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spelling	oai:doaj.org-article:3d755b96afba4023bfee83be1ec7df9d2021-12-02T07:13:41ZThe Effect of Fusion Added to Lumbar Discectomy in Patients with Modic Changes: A Retrospective Comparative Outcome Analysis Regarding Back Pain Control10.21608/esj.2019.4911.10622314-89502314-8969https://doaj.org/article/3d755b96afba4023bfee83be1ec7df9d2018-10-01T00:00:00Zhttp://www.esj.journals.ekb.eg/article_26434.htmlhttps://doaj.org/toc/2314-8950https://doaj.org/toc/2314-8969Background Data: In 1988, Modic et al first described magnetic resonance (MR) degenerative changes in the lumbar vertebral bodies. changes in the intervertebral endplates, Modic Changes (MC) can also be incriminated in the production of such pain due to the mechanical failure and structural changes that can be detected the most in the region of the highly pain sensitive intervertebral endplates. There is still a controversy regarding the surgical treatment of the predominantly axial pain secondary to degenerative lumbar disc disease. Study Design: This is a retrospective cohort study. Purpose: To evaluate the effect of adding fusion to simple discectomy in treatment of patients of lumbar disc herniation that show evidence of MC on preoperative MR images regarding the control of postoperative back pain and functional outcome. Patients and Methods: This study included 44 patients who underwent surgical management of low back pain and/or sciatica due to lumbar intervertebral disc herniation with concomitant presence of Modic changes in the preoperative MR images. Patients were divided into two groups: Group A (Discectomy group), and Group B (Fusion group). Patients included had single level lumbar disc herniation with modic changes. Patients with radiographic evidence of instability and patients whose 1-year post-operative data were incomplete were excluded. Twenty five patients were males and 19 were females with a mean age of 43.48 years. Nineteen patients (43.2%) were allocated in Group A and 25 patients (56.8 %) in Group B. Clinical results and functional outcome were assessed based on changes in preoperative and postoperative Visual Analogue Scale (VAS) of low back pain and Oswestry Disability Index (ODI) scores of the functional disability. Results: Postoperative back pain improvement was statistically significant in both groups when comparing preoperative values of VAS using paired student-t test with P<0.001 for both groups. Comparison of post-operative back pain VAS for both groups using independent student-t test revealed a statistically non-significant difference with a P=0.239 (Mean VAS for group A=2.211 while mean VAS for Group B=1.48). Conclusion: Unless otherwise indicated, simple lumbar discectomy without fusion is a reasonable surgical option in treatment of patients with lumbar intervertebral disc herniation even in the presence of Modic changes in their pre-operative MRI. (2018ESJ167) Ahmad Elsayed Desoukey Elayouty, MD., Walid Ahmed Abdel Ghany, MD.Egyptian Spine AssociationarticleModic changeslumbar discectomylow back painLumbar fusionNeurology. Diseases of the nervous systemRC346-429ENEgyptian Spine Journal, Vol 28, Iss 1, Pp 40-47 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Modic changes lumbar discectomy low back pain Lumbar fusion Neurology. Diseases of the nervous system RC346-429
spellingShingle	Modic changes lumbar discectomy low back pain Lumbar fusion Neurology. Diseases of the nervous system RC346-429 Ahmad Elsayed Desoukey Elayouty, MD., Walid Ahmed Abdel Ghany, MD. The Effect of Fusion Added to Lumbar Discectomy in Patients with Modic Changes: A Retrospective Comparative Outcome Analysis Regarding Back Pain Control
description	Background Data: In 1988, Modic et al first described magnetic resonance (MR) degenerative changes in the lumbar vertebral bodies. changes in the intervertebral endplates, Modic Changes (MC) can also be incriminated in the production of such pain due to the mechanical failure and structural changes that can be detected the most in the region of the highly pain sensitive intervertebral endplates. There is still a controversy regarding the surgical treatment of the predominantly axial pain secondary to degenerative lumbar disc disease. Study Design: This is a retrospective cohort study. Purpose: To evaluate the effect of adding fusion to simple discectomy in treatment of patients of lumbar disc herniation that show evidence of MC on preoperative MR images regarding the control of postoperative back pain and functional outcome. Patients and Methods: This study included 44 patients who underwent surgical management of low back pain and/or sciatica due to lumbar intervertebral disc herniation with concomitant presence of Modic changes in the preoperative MR images. Patients were divided into two groups: Group A (Discectomy group), and Group B (Fusion group). Patients included had single level lumbar disc herniation with modic changes. Patients with radiographic evidence of instability and patients whose 1-year post-operative data were incomplete were excluded. Twenty five patients were males and 19 were females with a mean age of 43.48 years. Nineteen patients (43.2%) were allocated in Group A and 25 patients (56.8 %) in Group B. Clinical results and functional outcome were assessed based on changes in preoperative and postoperative Visual Analogue Scale (VAS) of low back pain and Oswestry Disability Index (ODI) scores of the functional disability. Results: Postoperative back pain improvement was statistically significant in both groups when comparing preoperative values of VAS using paired student-t test with P<0.001 for both groups. Comparison of post-operative back pain VAS for both groups using independent student-t test revealed a statistically non-significant difference with a P=0.239 (Mean VAS for group A=2.211 while mean VAS for Group B=1.48). Conclusion: Unless otherwise indicated, simple lumbar discectomy without fusion is a reasonable surgical option in treatment of patients with lumbar intervertebral disc herniation even in the presence of Modic changes in their pre-operative MRI. (2018ESJ167)
format	article
author	Ahmad Elsayed Desoukey Elayouty, MD., Walid Ahmed Abdel Ghany, MD.
author_facet	Ahmad Elsayed Desoukey Elayouty, MD., Walid Ahmed Abdel Ghany, MD.
author_sort	Ahmad Elsayed Desoukey Elayouty, MD.,
title	The Effect of Fusion Added to Lumbar Discectomy in Patients with Modic Changes: A Retrospective Comparative Outcome Analysis Regarding Back Pain Control
title_short	The Effect of Fusion Added to Lumbar Discectomy in Patients with Modic Changes: A Retrospective Comparative Outcome Analysis Regarding Back Pain Control
title_full	The Effect of Fusion Added to Lumbar Discectomy in Patients with Modic Changes: A Retrospective Comparative Outcome Analysis Regarding Back Pain Control
title_fullStr	The Effect of Fusion Added to Lumbar Discectomy in Patients with Modic Changes: A Retrospective Comparative Outcome Analysis Regarding Back Pain Control
title_full_unstemmed	The Effect of Fusion Added to Lumbar Discectomy in Patients with Modic Changes: A Retrospective Comparative Outcome Analysis Regarding Back Pain Control
title_sort	effect of fusion added to lumbar discectomy in patients with modic changes: a retrospective comparative outcome analysis regarding back pain control
publisher	Egyptian Spine Association
publishDate	2018
url	https://doaj.org/article/3d755b96afba4023bfee83be1ec7df9d
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The Effect of Fusion Added to Lumbar Discectomy in Patients with Modic Changes: A Retrospective Comparative Outcome Analysis Regarding Back Pain Control

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