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. 2020 Mar;17(1):190-203.
doi: 10.14245/ns.2040062.031. Epub 2020 Mar 31.

The Impact of Modic Changes on Preoperative Symptoms and Clinical Outcomes in Anterior Cervical Discectomy and Fusion Patients

James D Baker  1   2 , Garrett K Harada  1   2 , Youping Tao  3 , Philip K Louie  1   2 , Bryce A Basques  1   2 , Fabio Galbusera  4 , Frank Niemeyer  3 , Hans-Joachim Wilke  3 , Howard S An  1   2 , Dino Samartzis  1   2
Affiliations

The Impact of Modic Changes on Preoperative Symptoms and Clinical Outcomes in Anterior Cervical Discectomy and Fusion Patients

James D Baker et al. Neurospine. 2020 Mar.

Abstract

Objective: To assess the impact of Modic changes (MC) on preoperative symptoms, and postoperative outcomes in anterior cervical discectomy and fusion (ACDF) patients.

Methods: We performed a retrospective study of prospectively collected data of ACDF patients at a single institution. Preoperative magnetic resonance imagings were used to assess the presence of MC. MC were stratified by type and location, and compared to patients without MC. Associations with symptoms, patient-reported measures, and surgical outcomes were assessed.

Results: A total of 861 patients were included, with 356 patients with MC (41.3%). MC more frequently occurred at C5-6 (15.1%), and type II was the most common type (61.2%). MC were associated with advanced age (p < 0.001), more levels fused (p < 0.001), a longer duration of symptoms, but not with specific symptoms. MC at C7-T1 resulted in higher postoperative disability (p < 0.001), but did not increase risk of adjacent segment degeneration or reoperation.

Conclusion: This study is the first to systematically examine the impact of cervical MC, stratified by type and location, on outcomes in ACDF patients. Patients with MC were generally older, required larger fusions, and had longer duration of preoperative symptoms. While MC may not affect specific outcomes following ACDF, they may indicate a more debilitating preoperative state for patients.

Keywords: Diskectomy; Intervertebral disc degeneration; Magnetic resonance imaging; Patient outcome assessment; Spine.

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Conflict of interest statement

The authors have nothing to disclose.

Figures

Fig. 1.
Fig. 1.
(A) A T1-weighted magnetic resonance imaging (MRI) of a 59-year-old female demonstrating hypointensity at the inferior endplate of C4. (B) A T2-weighted MRI of the same patient demonstrating hyperintensity, suggesting a type I Modic change. She went on to have a 2-level anterior cervical discectomy and fusion procedure of C4–6. Arrows indicate the location of the identified Modic change lesion on T1- (A) and T2-weighted (B) imagings.
Fig. 2.
Fig. 2.
(A) A T1-weighted magnetic resonance imaging (MRI) of a 41-year-old female that shows hyperintensity at the posterior-inferior endplate of C5 and the posterior-superior endplate of C6. (B) The T2-weighted MRI also demonstrates hyperintensity, suggesting a type II modic change. She went on to have a 2-level anterior cervical discectomy and fusion procedure of C4–6. Arrows indicate the location of the identified Modic change lesion on T1- (A) and T2-weighted (B) imagings.
Fig. 3.
Fig. 3.
(A) T1-weighted MRI of a 50-year-old female demonstrating hypointensity at the posterior-superior endplate of C3. (B) T2-weighted MRI of the same patient also demonstrating hypointensity at C3, suggesting a type III Modic change. She underwent a 2-level anterior cervical discectomy and fusion procedure of C5–7. Arrows indicate the location of the identified Modic change lesion on T1- (A) and T2-weighted (B) imagings.
Fig. 4.
Fig. 4.
Distribution of Modic changes by cervical spinal level. Data labels show the percentage of all patients with Modic changes in the context of the entire study population.
Fig. 5.
Fig. 5.
Distribution of Modic changes stratified by type and level in the cervical spine. Type I Modic changes are represented in grey, type II are represented in orange, and type III are represented in blue. Data levels show the percentage of total Modic changes of that type at each level.
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References

    1. Modic MT, Steinberg PM, Ross JS, et al. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988;166(1 Pt 1):193–9. - PubMed
    1. Dudli S, Fields AJ, Samartzis D, et al. Pathobiology of Modic changes. Eur Spine J. 2016;25:3723–34. - PMC - PubMed
    1. de Roos A, Kressel H, Spritzer C, et al. MR imaging of marrow changes adjacent to end plates in degenerative lumbar disk disease. AJR Am J Roentgenol. 1987;149:531–4. - PubMed
    1. Schmid G, Witteler A, Willburger R, et al. Lumbar disk herniation: correlation of histologic findings with marrow signal intensity changes in vertebral endplates at MR imaging. Radiology. 2004;231:352–8. - PubMed
    1. Zhang YH, Zhao CQ, Jiang LS, et al. Modic changes: a systematic review of the literature. Eur Spine J. 2008;17:1289–99. - PMC - PubMed