title: Predictive value of MRI vertebral end-plate signal changes (Modic) on outcome of surgically treated degenerative disc disease. Results of a cohort study including 60 patients.
abstract: OBJECTIVE
  To assess the predictive value of MRI vertebral end-plate changes (Modic) on clinical outcome of surgically treated lumbar single-level degenerative disc disease (DDD).
  
  
  METHODS
  A cohort of 60 patients was included. Patient groups were similar in respect of age, gender and clinical presentation, allowing comparisons. Patient age ranged from 30 to 72 years (mean: 45.8 years). All patients suffered severe chronic low back pain for more than 6 months, with single-level symptomatic DDD. All patients experienced segmental instrumented interbody (n = 22) or posterolateral (n = 38) fusion. Clinical outcome was assessed by using a visual analog scale (VAS) and the functional disability scale of the Japanese Orthopaedic Association (JOA) for lumbar spine. The number of patients for each Modic group was as follows: Modic type 0, n = 15; Modic type I, n = 22; Modic type II, n = 14; and Modic type I/II, n = 9. Fusion rates were similar for each Modic group of patients. Mean follow-up was 14 months.
  
  
  RESULTS
  The pre-operative mean VAS improved by 53.5% (from 8.2+/-2.0 to 3.8+/-1.9, p < 0.05) and the pre-operative mean JOA score by 58% (from 5.5+/-2.1 to 11.0+/-2.4, p < 0.05). Patients harboring Modic type I changes improved much better than others (p < 0.05). Conversely, clinical outcome of patients presenting with Modic type II lesions was poor.
  
  
  CONCLUSIONS
  This study confirms instrumented fusion as an effective treatment in symptomatic lumbar DDD. Preoperative combination of low back pain of discal origin and severe DDD with Modic type I lesion on MRI may lead to excellent results after fusion in a large proportion of patients. Conversely, arthrodesis for patients harboring Modic type II abnormalities implicates smaller benefit of doubtful clinical significance.
authors.affiliation: Service de Neurochirurgie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg Cedex. philippe.Esposito@chru-strasbourg.fr
authors.forename: Ph
authors.initials: P
authors.lastname: Esposito
authors.forename: J L
authors.initials: JL
authors.lastname: Pinheiro-Franco
authors.forename: S
authors.initials: S
authors.lastname: Froelich
authors.forename: D
authors.initials: D
authors.lastname: Maitrot
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013122:Spinal Diseases / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome