Study On The Efficacy Of Different Surgical Treatment For Lumbar Disc Herniation Combined With Modic Changes

Objective: 1.To explore the effect of different surgical methods in the treatment of lumbar disc herniation with Modic changes.2.To explore the surgical methods of different types of Modic changes in lumbar disc herniation.3.To provide specific reference for clinical treatment of lumbar disc herniation with Modic changes.Methods: Retrospective analysis 85 patients suffering from lumbar disc herniation in the department of orthopedics,affiliated hospital of North Sichuan Medical College from June 2013 to June 2018,all cases were combined with Modic changes and were divided into four groups.The first group was A group,29 cases,treated with the posterior lumbar discectomy.The second group was B group,32 cases,treated with percutaneous endoscopic transforaminal discectomy(PETD).Another two groups(C group and D group)were treated with posterior lumbar interbody fusion(PLIF),11 cases in group C were treated with bilateral internal fixation,while 13 cases in group D treated with unilateral internal fixation.Preoperative,postoperative and intergroup effects were compared in each group.Evaluation index: VAS and ODI scales.Follow-up way: outpatient or telephone follow-up.Results: After surgery,all cases need at least 6 months follow-up(range 6-34 months),with an average follow-up of 14.2 months.A group of 29 cases,13 males and 16 females,aged 30 to 73 years old(mean 48.55years),in which 14 cases were L4/L5 disc herniation and 15 cases were L5/S1 disc herniation 9 cases of Modic I type,20 cases of type II.The VAS and ODI scores of preoperative were respectively 7.72±1.73 ? 8.62±1.52 ?38.03±3.58,and postoperative followed-up VAS and ODI scores were respectively 2.00±1.51?2.89±1.57?10.69±6.92.B group of 32 cases,13 males and 19 females,aged 23 to 81 years old(mean 49.62 years),in which 14 cases were L4/L5 disc herniation and 18 cases were L5/S1 disc herniation,11 cases of Modic I type,21 cases of type II.The VAS and ODI scores of preoperative were respectively 7.53±2.59 ? 8.53±1.24 ? 37.41±4.35,and postoperative followed-up VAS and ODI scores were respectively 2.25±2.08?2.66±2.29?11.16±10.09.C group of 11 cases,4 males and 7 females,aged 41 to 65 years old(mean 50.08years),in which 5 cases were L4/L5 disc herniation and 6 cases were L5/S1 disc herniation 3 cases of Modic I type,8 cases of type II.The VAS and ODI scores of preoperative were respectively 7.77±2.09?8.31±2.14?38.38±3.73,and postoperative followed-up VAS and ODI scores were respectively 0.62±0.61?1.54±0.97?1.77±1.96.D group of 13 cases,5 males and 8 females,aged 41 to 76 years old(mean 51.18 years),in which 6 cases were L4/L5 disc herniation and 7 cases were L5/S1 disc herniation,9 cases of Modic I type,20 cases of type II.The VAS and ODI scores of preoperative were respectively 7.82±1.72 ? 8.91±1.22 ? 38.64±4.13,and postoperative followed-up VAS and ODI scores were respectively 0.73±1.72?1.82±1.83?2.91±2.34.Preoperative and postoperative VAS and ODI scores of all groups were analyzed by Student's t test.There was no difference in preoperative VAS and ODI scores between each group(P>0.05).The VAS and ODI scores were reduced obviously after surgery,the postoperative low back pain of all patients were significantly relieved and the function of lumbar spine were improved.There was no significant difference in postoperative VAS and ODI scores between group A and group B,group C and group D(P>0.05).However,there were significant differences in low back pain VAS score and ODI score between the non-fusion group(group A + group B)and the fusion group(group C + group D)with Modic I type and type II changes(P<0.05).Conclusion:1.Posterior lumbar discectomy and percutaneous endoscopic lumbar discectomy are effective methods for the treatment of lumbar disc herniation with Modic changes.There was no significant difference in the clinical efficacy for the treatment of lumbar disc herniation combined with Modic change.2.In posterior lumbar interbody fusion(PLIF),there was no significant difference in the clinical efficacy between unilateral and bilateral internal fixation for the treatment of lumbar disc herniation combined with Modic changes.3.The clinical efficacy of PLIF is superior to posterior lumbar discectomy and PETD for the treatment of lumbar disc herniation with Modic changes.It may be due to the lumbar discectomy only removed the degenerative nucleus pulposus but did not treat the diseased endplate.Modic changes in the endplate can produce inflammatory factors continuously stimulating the nerves to produce pain,so patients may have lower back pain residues after surgery.4.Modic I and Modic II changes had no significant effect on surgical outcomes.5.Interbody fusion with unilateral pedicle screw fixation is an ideal procedure for the treatment of lumbar disc herniation with Modic changes.