Low back pain after lumbar discectomy in patients showing endplate modic type 1 change.
METHODS
Prospective cohort study.


OBJECTIVE
To examine the relationship between low back pain after discectomy for disc herniation and Modic type 1 change.


BACKGROUND
Lumbar vertebral bone marrow change is divided into Modic types. Some reports indicate that Modic type 1 is related to low back pain, but the reliability of this assertion is unclear. The current study examines changes in low back pain in patients with lumbar disc herniation and Modic type 1 change after lumbar discectomy without fusion surgery.


METHODS
Forty-five patients with lumbar disc herniation showing normal or Modic type 1 signals in their bone marrow were selected (mean age 35 years). All patients suffered low back and leg pain because of lumbar disc herniation, and underwent a discectomy without fusion. We evaluated change in low back pain [Visual analogue scale (VAS) score, Japanese Orthopedic Association score (JOAS), and Oswestry Disability Index (ODI)] before, 12 and 24 months after surgery.


RESULTS
Twenty-three patients showed Modic type 1 signals and 22 patients showed normal intensity before surgery. VAS score, JOAS, and ODI were not significantly different between the normal and Modic type 1 groups. VAS score, JOAS, and ODI improved after surgery in both groups (P>0.05). Low back pain after surgery evaluated from the 3 scores was not significantly different in the 2 groups 12 or 24 months after surgery (P>0.05).


CONCLUSIONS
Discectomy improved low back pain in patients suffering from lumbar disc herniation. Patients with or without Modic type 1 change showed a similar improvement of low back pain score. Low back pain in patients with disc herniation appears to mainly originate from disc or nerve root compression, and decompression surgery without fusion is an option for these patients, even those with Modic type 1 changes.
Ohtori
Seiji
S
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. sohtori@faculty.chiba-u.jp
Yamashita
Masaomi
M
Yamauchi
Kazuyo
K
Inoue
Gen
G
Koshi
Takana
T
Suzuki
Munetaka
M
Orita
Sumihisa
S
Eguchi
Yawara
Y
Ochiai
Nobuyasu
N
Kishida
Shunji
S
Takaso
Masashi
M
Aoki
Yasuchika
Y
Ishikawa
Tetsuhiro
T
Arai
Gen
G
Miyagi
Masayuki
M
Kamoda
Hiroto
H
Nakamura
Junichi
J
Takahashi
Kazuhisa
K
D000293:Adolescent; D000328:Adult; D017586:Diskectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000601:surgery; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery*; D017116:Low Back Pain / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D010147:Pain Measurement; D011446:Prospective Studies; D011859:Radiography; D055815:Young Adult