Relationship between the Course of Modic Changes Type I Accompanying Herniated Lumbar Disc and LBP Outcome by Different Surgical Modalities

Background: Suspected as a cause of Low Back Pain (LBP), Modic changes (MCs) have received increasing attention in spine research and care. To the author s knowledge, studies concerned with (MCs) are very limited. Objective: The aim of the present study is to assess LBP outcome in patients with lumbar disc herniation associated with (MCs) type I after lumbar discectomy with or without fusion. Patients and Methods: This is prospective study done on 36 patients with lumbar disc herniation associated with (MCs) type I (potentially unstable). All patients suffered LBP and leg pain and underwent a discectomy with or without fusion between March 2010 and March 2013. All patients were operated upon in Ain-Shams University Hospitals (Cairo, Egypt). All patients were studied clinically and radiologically before and after any procedure. Results: 36 patients (20 malesand 16 females) with herniated lumbar disc (HLD) associated with (MCs) type I were included in this study. 12 patients (7 males and 5 females underwent a discectomy alone (group A). 12 patients (7 males and 5 females) had posterior lumbar inter-body fusion (PLIF) (group B). Twelve patients (6 males and 6 females) had a discectomy and postero-lateral fusion (group c). At the final follow up, (MCs) type I became more sizable after surgery in 6 patients (only in group A) but still the same size and type in 3 patients (one patient in each group). Modic changes type I converted into (MCs) type II in 15 patients (2 patients in group A, 8 patients in group B and 5 patients in group C) 12 patients had a mixed type (I/II) of (MCs) after surgery at the final follow up (3 patients in group A, 3 patients in group B and 6 patients in group C). Conclusion: This study suggests that(MCs) type I are dynamic lesions. It’s thought that, by lumbar fusion -especially interbody fusion- this (MCs) type I will be more stable, less painful due to lumbarfusion enhances conversion of (MCs) type I to type II which is more likely stable and not painful.