The Efficacy Of Microendoscopic Discectomy For Disc Herniation Complicated With Lumbar Endplate Modic Changes

Objective:In this study, follow-up observation on68cases of lumbar disc herniation with endplate Modic change to evaluate the clinical outcomes of microendoscopic discectomy (MED) in intervertebral disc herniation with Modic changes.Methods:98patients including53mals and45femals, aged from21to61years old (mean48.3years) suffering from single level disc herniation in L4-L5or L5-S1from May2007to June2011were reviewed retrospectively, of them,33had no lumbar endplate Modic changes (group A),65had lumbar endplate Modic changes (group B), cases with Modic Ⅰ,Ⅱ,Ⅲ-type accounted23,31,11, respectively.All patients underwent microendoscopic discectomy and at least6month follow-up(mean28.4months), the VAS and ODI scales at the preoperative and final follow-up were compared between two groups.Results:The symptoms of all the patients were relieved postoperatively. The postoperative scores of VAS and ODI of the PLIF group were better than those of the MED group, and the differences were statistically significant (P<0.05). The improvement rate of ODI of the MED group and the PLIF group were81.3%and84.8%, respectively; and the improvement rate of VAS were77.2%and86.8%, respectively. In the PLIF group, the improvement rate of VAS (low back pain) of Modic type Ⅰ was better than that of Modic type Ⅱ, and the difference was statistically significant (P<0.05); and in the MED group, the differences of VAS and ODI scores between different Modic types weren’t statistically significant (P>0.05).Conclusions:MED is effective for lumbardisc herniation, Modic changes in endplate may lead to postoperative low back pain, and even poor prognosis, moreover the outcomes of MED for different types of Modic changes remain no difference.