| Objective with the application of MRI , the diagnose of the spine disorders become more accurate ,The endplate changes often happen on the patients diagnosed disc degenerative disease(DDD),at the end of 1980', Modic et al described the significant changes of the endplates and called the Modic changes . Endplate changes are divided into 3 types according to Modic, different Modic types have different clinical significance, at present ,there are many researches about the Modic types,treatment and the relevance of low back pain , but they are still controversial, as we have known, there are few reports on the Lumbar disc herniation with Modic changes . The purposes of our research are : first, to further explore the relationship between Modic changes and low back pain; second, to discuss outcomes of the different surgical treatments of lumbar disc herniation with Modic changes ; third to study the lumbar disc herniation associated with Modic changes in the pathological changes.Methods from September of 2003 to December of 2008, 89 cases were enrolled, of which 30 cases were simple lumbar disc herniation, and 59 cases disc herniation with Modic changes, all cases were divided into 3 groups, the first group was A group, 30 cases were diagnosed simple singlesegment disc herniation, and received the microendoscopic discectomy(MED), the second group was B group, 30 cases, MRI examination found lumbar disc herniation with Modic changes(Modicâ… types in 10 cases,Modicâ…¡type changes in 20 cases), also underwent the treatment of MED, the third is C group ,29 cases , MRI examination found lumbar disc herniation with Modic changes(Modicâ… types in 5 cases,Modicâ…¡type changes in 24 cases),all patient underwent the Transforaminal Lumbar Interbody Fusion(TLIF) ,clinical outcome of each group were observed, and results of pretreatment were compared with those of posttreatment in each group, as well as results among groups. Staining the degenerated endplate cartilage in C group with HE and immunohistochemical staining, we observed the pathological changes. evaluating indicator : visual pain analogue scale(VPAS),Oswestry disability index(ODI),0.5-5 year follow-up by out-patient clinic,mail and telephone.Results 0.5-5 years follow-up, average 38 months, A group of 30 cases, 21 males and 9 females, average age of 42.5 years (21-68 years old), in which 16 cases were L4-5 disc herniation , 14 cases were L5-S1 disc herniation. The VPAS and ODI of preoperative average score were 7.76 (7-10) ,36.87 (35-39), and postoperative follow-up VPAS and ODI were 1.63 (0-3), 6.06 (4-8); B group: 16 males and 14 females, average age: 46.8 years (33-71 years old) ,of which 4 patients were L4-5 disc herniation, 26 cases were L5-S1 disc herniation, and VPAS and ODI preoperative average score were 8.03 (7-10), 39.36 (38-42), postoperative follow-up VPAS and ODI average score were 3.14 (1-4) and 11.63 (8-15); C group: 29 cases, 10 males and 19 females, average age: 47.3 years (25-73 years old), of which 13 patients were L4-5 disc herniation, 16 were L5-S1 disc herniation. Preoperative VPAS and ODI of average score were 8.4 (7-10) and 39.83 (38-42), postoperative follow-up of VPAS and ODI average score were 1.43 (1-3) and 6.9 (4-10) ; the VPAS and ODI score of preoperative and postoperative in three groups patients were analyzed by paired t test, P <0.05, lumbar function of all patients improved significantly, ODI score was significantly lower than that of preoperative. There were no significant differences in pre-operative VAS and ODI score among three groups, P> 0.05; but there were significant difference in postoperative score of VAS and ODI between A group and B group, P <0.05; there were significant differences in postoperative score of VAS and ODI between C group and B group, P <0.05. HE staining of Modic changesâ…¡type indicated: first. The degenerated cartilage endplate presented a typical cartilage organizational structure. Near the bone endplate, cartilage endplate expressed the hyaline cartilage organization; while near the nucleus pulposus, cartilage endplate began to form fibrocartilage; Second. No clear lamellar-like structure in end-plate calcification zone were found in a the slices.â… ,â…¡collagen immunohistochemical staining showed: irregular coloring in shallow cartilage region can be seen inâ… collagen immunohistochemistry stained cartilage with the color of light brown, Modic changesâ…¡types showed that there were fiber-like tissue of hyperplasia in tissue. Conclusion1. Modic changes has correlation with low back pain and affected the outcomes of treatment for lumbar disc herniation;2. Treatment with MED of simple single-segmental lumbar disc herniation and single-segmental lumbar disc herniation associated with Modic changes are effective, but no change in endplate is better than Modic changes.3. The treatment of minimally invasive TLIF and MED for the lumbar disc herniation associated with Modic changes are effective, but curative effect of TLIF minimally invasive is better than MED for the lumbar disc Herniation with Modic changes.4. HE and immunohistochemical staining showed Modic changesâ…¡type histological changes in morphological changes in the endplate cartilage lesions there are expression there is Expression of typeâ… collagen...
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