Tian Qing-Hua, Lu Ying-Ying, Sun Xi-Qi, Wang Tao, Wu Chun-Gen, Li Ming-Hua, Cheng-Ying Sheng
Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yi Shan Road, Shanghai 200233, China.
Pain Physician. 2017 May;20(4):E481-E488.
Treatment of symptomatic lumbar disc herniation with Modic type I endplate changes is complex and challenging, requiring systemic and local therapies which include conservative therapy, epidural infiltrations, percutaneous therapeutic techniques, and surgical options. The clinical management of symptomatic lumbar disc herniation involving Modic type I endplate changes is uniquely challenging because it requires alleviating pain caused by both the herniated disc and the endplate osteochondritis. Through different approaches, percutaneous lumbar discectomy (PLD) and percutaneous cementoplasty (PCP) have been introduced into clinical practice as alternatives to traditional surgical and radiotherapy treatments of symptomatic lumbar disc herniation and other spine diseases.
To evaluate the feasibility of PLD and PCP for symptomatic lumbar disc herniation with Modic type I endplate changes.
PLD and PCP in 7 patients with symptomatic lumbar disc herniation with Modic type I endplate changes and its clinical effects were retrospectively evaluated.
This study was conducted by an interventional therapy group at a medical center in a major Chinese city.
Seven consecutive patients (2 men, 5 women; median age, 74.14 ± 5.34 years; age range, 68 - 82 years) who underwent percutaneous lumbar discectomy and cementoplasty for the treatment of symptomatic lumbar disc herniation with Modic type I changes between May 2013 and August 2015 were retrospectively analyzed. The MacNab Criteria, visual analog scale (VAS), and Oswestry Disability Index (ODI) for pain were assessed before and one week, 6 months, and one year after the procedure. Furthermore, the procedure duration, hospital stay length, and complications were assessed.
The VAS of the back and leg decreased from 6.14 ± 0.69 (range, 5 - 7) and 7.29 ± 0.76 (range, 6 - 8) preoperatively to 2.29 ± 1.38 (range, 1 - 5) and 2.71 ± 0.60 (range, 1 - 6) one week, 1.86 ± 0.69 (range, 1 - 3) and 2.00 ± 0.58 (range, 1 - 3) 6 months, and 1.71 ± 0.76 (range, 1 - 3) and 1.85 ± 0.69 (range, 1 - 3) one year postoperatively. The ODI dropped from 76.86 ± 7.45 (range, 70 - 82) preoperatively to 26.29 ± 19.47 (range, 16 - 70) one week, 19.14 ± 2.79 (range, 16 - 24) 6 months, and 18.57 ± 2.99 (range, 16 - 24) one year postoperatively. The mean procedure duration was 55.71 ± 6.07 minutes (range, 50 - 65 minutes). The average length of hospital stay was 7.57 ± 1.27 days (range, 6 - 10 days). No obvious complications were noted.
This was a retrospective study with a relatively small sample size.
PLD plus PCP is a feasible technique for symptomatic lumbar disc herniation with Modic type I endplate changes.
治疗伴有Modic I型终板改变的症状性腰椎间盘突出症复杂且具有挑战性，需要全身和局部治疗，包括保守治疗、硬膜外注射、经皮治疗技术和手术选择。涉及Modic I型终板改变的症状性腰椎间盘突出症的临床管理具有独特的挑战性，因为它需要减轻由突出的椎间盘和终板骨软骨炎引起的疼痛。通过不同的方法，经皮腰椎间盘切除术（PLD）和经皮骨水泥成形术（PCP）已被引入临床实践，作为症状性腰椎间盘突出症和其他脊柱疾病传统手术和放射治疗的替代方法。
评估PLD和PCP治疗伴有Modic I型终板改变的症状性腰椎间盘突出症的可行性。
回顾性评估7例伴有Modic I型终板改变的症状性腰椎间盘突出症患者的PLD和PCP及其临床效果。
本研究由中国一个主要城市的一家医疗中心的介入治疗组进行。
回顾性分析2013年5月至2015年8月期间连续7例（2例男性，5例女性；中位年龄74.14±5.34岁；年龄范围68 - 82岁）因伴有Modic I型改变的症状性腰椎间盘突出症接受经皮腰椎间盘切除术和骨水泥成形术的患者。在手术前以及手术后1周、6个月和1年评估疼痛的MacNab标准、视觉模拟量表（VAS）和Oswestry功能障碍指数（ODI）。此外，评估手术持续时间、住院时间和并发症。
背部和腿部的VAS从术前的6.14±0.69（范围5 - 7）和7.29±0.76（范围6 - 8）降至术后1周的2.29±1.38（范围1 - 5）和2.71±0.60（范围1 - 6）、6个月时的1.86±0.69（范围1 - 3）和2.00±0.58（范围1 - 3）以及1年时的1.71±0.76（范围1 - 3）和1.85±0.69（范围1 - 3）。ODI从术前的76.86±7.45（范围70 - 82）降至术后1周的26.29±19.47（范围16 - 70）、6个月时的19.14±2.79（范围16 - 24）和1年时的18.57±2.99（范围16 - 24）。平均手术持续时间为55.71±6.07分钟（范围50 - 65分钟）。平均住院时间为7.57±1.27天（范围6 - 10天）。未发现明显并发症。
这是一项样本量相对较小的回顾性研究。
PLD联合PCP是治疗伴有Modic I型终板改变的症状性腰椎间盘突出症的一种可行技术。
