[Selection of surgical methods for lumbar disc herniation with degenerative endplates changes]

Abstract

Objective: To analyze the selection of surgical methods for lumbar disc herniation with low back and leg pain and degenerative lumbar Modic endplate changes and their different postoperative therapeutic effects.

Methods: All 30 cases of single segment lumbar disc herniation accompanied by Modic endplate changes operated at our hospital using simple discectomy or decompressions with interbody fusion from January 2005 to January 2008 were retrospectively identified. There were 18 males and 12 females with an average age of 38.5 years old (26-53 years old) and an average follow-up of 21 months (4-40 months).

Results: Discectomy alone group included 15 cases. The average score of Japanese Orthopedics Association (JOA) and visual analysis scale (VAS) of low back pain and lower extremity radicular pain at the preoperative and final follow-up time was 13.2 (5-17), 6.8 (4-10), 4.8 (1-8) and 19.8 (14 -24), 4.8 (2-10), 1.2 (0-6) respectively. The average improvement rate of JOA was 41.9%. The difference of VAS of lower extremity radicular pain between pre and post-operation was 3.7 on average. Among these 15 cases, Modic I, II and I/II mixed-type was 5, 9, and 1 respectively. Decompression with interbody fusion group included 15 cases. VAS of low back pain and lower extremity radicular pain at the preoperative and final follow-up time was 12.9 (5-17), 7.0 (4-10), 4.9 (1-8) and 22.6 (19-28), 2.8 (2-8) and 1.3 (0-6) respectively. The average improvement rate of JOA was 63.4%. The differences of VAS of lower extremity radicular pain and low back pain between pre and post-operation were 4.3 and 3.6 on average respectively. Among these cases, Modic I, II and I/II mixed-type was 6, 8, and 1 respectively. Comparing the VAS of low back pain, JOA average score and the improvement rate of JOA score of two groups at pre-operation and post-operation, statistical analysis showed that decompression with interbody fusion group was superior to simple discectomy group.

Conclusion: For lumbar disc herniation with degenerative Modic endplate changes, who suffered more from low back pain than lower extremity radicular pain, discectomy alone and decompression with interbody fusion could both improve the degree of lower extremity radicular pain, but discectomy alone is less likely to improve the degree of low back pain and function score than the latter. So the maneuver of lumbar decompression with fusion is a better choice.