The influence of endplate (Modic) changes on clinical outcomes in lumbar spinal stenosis surgery: a Swiss prospective multicenter cohort study

European spine journal

article

Nils H. Ulrich¹  Jakob M. Burgstaller¹  Isaac Gravestock¹  Sebastian Winklhofer³  François Porchet⁴  Giuseppe Pichierri¹  Maria M. Wertli¹  Johann Steurer¹  Mazda Farshad² 

[1] Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich;University Spine Centre Zurich, Balgrist University Hospital, University of Zurich;Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich;Department of Orthopedics and Neurosurgery, Spine Center, Schulthess Clinic;Division of General Internal Medicine, Bern University Hospital, Bern University

关键词: Modic changes;    Endplate;    Decompression;    Degenerative lumbar spinal stenosis;    Fusion;   

DOI  :  10.1007/s00586-020-06364-0

来源: Springer

【 摘 要 】

To investigate if the presence or absence of preoperative endplate Modic changes (MC) is predictive for clinical outcomes in degenerative lumbar spinal stenosis (DLSS) patients undergoing decompression-alone or decompression with instrumented fusion surgery. Two hundred five patients were included and categorized into four groups; 102 patients into the decompression-alone group with MCs, 41 patients into the fusion group with MCs, 46 patients into the decompression-alone group without MCs, and 16 patients into the fusion group without MCs. Clinical outcome was quantified with changes in spinal stenosis measure (SSM) symptoms, SSM function, NRS pain, and EQ-5D-3L sum score over time (measured at baseline, 12-, 24-, and 36-month follow-up) and minimal clinically important difference (MCID) in SSM symptoms, SSM function, and NRS pain from baseline to 36-month follow-up. To investigate if possible effects of MCs had been modified or hidden by confounding variables, we used the group LASSO method to search for good prognostic models. There were no obvious differences in any of the clinical outcome measures between groups at baseline. At 12 months, most patients have improved in all outcomes and maintained improved conditions over time (no significant group differences). Between 70 and 90 percent of the patients maintained a clinically important improvement up to 36 months. Endplate MCs have no significant influence on clinical outcome parameters in patients with lumbar spinal stenosis compared to patients without MCs, independent of the chosen surgical strategy. All patients benefitted from surgical therapy up to 36-month follow-up. These slides can be retrieved under Electronic Supplementary Material.

【 授权许可】

Unknown