gms | German Medical Science

Objective: Modic type endplate changes (MCs) may be associated with chronic low back pain following lumbar discectomy. However, many aspects of MCs including pathophysiology and contributing factors are poorly understood. The purpose of this study was to document new appearance of MCs and accentuation in preexisting MCs after lumbar discectomy, and to assess associations between potential contributing factors and endplate changes.

Methods: This is a retrospective analysis of consecutive patients who underwent lumbar discectomy at our department between 01/2012 and 07/2014. Patients with preoperative magnetic resonance imaging (MRI) scan, that revealed no MCs at the surgical level, were assigned to group 1, and patients with evidence of MCs to group 2. The influence of surgery on MCs (new/accentuated MCs) in surgical and adjacent levels was depicted. Furthermore, association of demographic/baseline (age, gender, BMI) and inflammatory parameters (preoperative leukocyte count/CRP) with MCs was analyzed.

Results: 59 patients with a mean age of 59±15 years were included in our study (overall follow-up: 31 months), and were assigned to groups 1 (n=27) and 2 (n=32). 33.3% of patients in group 1 developed new MCs at the surgical level, and 11.1% at adjacent levels, predominantly (80%) Modic type 2. 3.1% of patients in group 2 showed accentuated MCs at the surgical level, and 9.4% new MCs at adjacent levels. Patients with new/accentuated MCs were significantly older (p=0.037) than patients without, while gender, BMI and inflammatory parameters did not contribute to MCs.

Conclusion: A lumbar discectomy seems to trigger the development of new MCs in surgical and adjacent levels, and older age might be a contributing factor. Preexisting MCs, however, are not accentuated by the procedure in a relevant way.