Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland.
University Spine Centre Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Eur Spine J. 2020 Sep;29(9):2205-2214. doi: 10.1007/s00586-020-06364-0. Epub 2020 Mar 10.
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.
研究术前终板 Modic 改变（MC）的存在与否是否对接受单纯减压或减压联合器械融合手术的退行性腰椎管狭窄症（DLSS）患者的临床结果具有预测性。
共纳入 205 例患者，分为四组；102 例减压组伴 MC，41 例融合组伴 MC，46 例减压组无 MC，16 例融合组无 MC。通过 SSM 症状、SSM 功能、NRS 疼痛的变化以及 EQ-5D-3L 总分随时间的变化（基线、12、24 和 36 个月随访时测量），以及 SSM 症状、SSM 功能和 NRS 疼痛从基线到 36 个月随访时的最小临床重要差异（MCID）来量化临床结果。为了研究 MC 是否被混杂变量改变或隐藏了可能的影响，我们使用组 LASSO 方法来寻找良好的预后模型。
各组基线时各临床结局指标均无明显差异。在 12 个月时，大多数患者在所有结局方面都有改善，并且随着时间的推移保持改善（无显著组间差异）。70%至 90%的患者在 36 个月时保持了有临床意义的改善。
与无 MC 的患者相比，腰椎管狭窄症患者的终板 MC 对临床结果参数没有显著影响，与所选择的手术策略无关。所有患者在 36 个月随访时都从手术治疗中获益。这些幻灯片可以在电子补充材料中检索到。
