Can End Plate Modic Changes Help in Predicting Outcome after Lumbar Disc Surgery
Razvi Rasi, Vinu V Gopal, Manish Joseph MathewBackground:
Surgical outcome after lumbar microdiscectomy (LMD) is determined by several factors. Relief of low backache is determined by several factors, the state of vertebral end plate being one of them. However, relation between specific Modic end plate changes and postoperative pain and disability is not extensively studied which we aim to address in this study.
Objective:
To investigate whether the presence of specific types of vertebral end plate change could assist in predicting the outcome following LMD.
Material and Methods:
Eighty patients posted for microlumbar discectomy were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) score for pre- and postoperative pain and disability, respectively. Magnetic resonance imaging (MRI) of the lumbosacral spine was used to assess the type of end plate. The relationship between different types of end plate Modic changes and postoperative outcome was analyzed with appropriate statistical tests.
Results:
Mean preoperative VAS score was 6.46 and majority (93.8%) of the patients were severely disabled (ODI score >40%). On MRI, 71.2% had type 2 Modic changes followed by type 3 (15.5%) and type 1 (13.8%) changes. Type 2 Modic changes on MRI were found to have significant association with better immediate improvement in terms of VAS pain score (
Conclusion:
Patients with type 2 Modic changes had better postoperative outcomes in terms of improvement in backache and reduction of disability.