The Influence Of Modic Changes Of Lumbar Endplate On The Spontaneous Absorption Of Herniated Intervertebral Disc

Objective:To study the influence of Modic changes of lumbar endplate on the spontaneous absorption of herniated intervertebral discMethods:Fifty-five patients suffering from herniation of lumbar intervertebral disc, without recurrence or former operation,and excluding pathological disease,were chosen for the study.Among them,men:35 and women:20.Mean age of all patients was 41 years(range,20-66 years).All patients underwent X-ray,CT and MRI examnination and diagnosed as herniation of lumbar intervertebral disc clinically; furthermore they were confirmed during operation.The patients were classified two groups(Modic changes and non-Modic changes) by the criteria of Modic changes. Every operative specimen was collected.Component analysis,HE and immunohistochemistry staining for CD34 and CD68 were performed.Results:1,Component of herniated tissueMean weight of all herniated tissue is 2.9±0.4g(0.8-5.0g ).Average component of all specimens is of 37%annulus fibrosus,55%nucleus pulposus and 8%hyaline cartilage in non-Modic changes group,while 33%annulus fibrosus,19%nucleus pulposus and 51%hyaline cartilage in Modic changes group.There are significantly difference between the content of hyaline cartilage and nucleus pulposus of the two groups(p＜0.05).2,Pathological changes of herniated tissueGranulation tissue with macrophages around new blood vessels was found in 90% of the herniated tissues.Granulation tissue is usually around the peripheral of herniated tissue.In some specimens,granulation tissues penetrating herniated tissue can be seen. New vascular endothelial cell in granulation tissue was verified by CD34 staining.Cell infiltrating around granulation tissue presents positive CD68 staining.Furthermore,in non-Modic changes group neovascularization was obviously,but Modic changes group was not.After statistical analysis,there was a significant difference between the extent of neovascularization of two groups.Conclusions:1,Herniated tissue of lumbar intervertebral discs with Modic changes in MRI contained more hyaline cartilage and less granulation tissues penetration and cell infiltration.It showed the herniated tissues of these discs was difficult to be absorpted. But,it needs prospective study.2,Patients of lumbar intervertebral disc herniation with non-Modic changes in MRI can be treated by conservative treatment with positive follow-up.But for Modic changes group,surgical treatment might be the first choice.