Department of Orthopedic Surgery, Mayor Clinic, Rochester, MN, USA.
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
Neurosurg Rev. 2024 Aug 29;47(1):504. doi: 10.1007/s10143-024-02570-2.
Modic changes (MCs) in the cervical spine are common, but remain an under-researched phenomenon, particularly regarding their prevalence, natural history, risk factors, and implications for surgical outcomes. This systematic review and meta-analysis endeavors to elucidate the multifactorial dimensions and clinical significance of cervical MCs.
Following PRISMA guidelines, a comprehensive systematic search was performed using Medline (via PubMed), EMBASE, Scopus, and Web of Science databases from their dates of inceptions to September 4, 2023. All identified articles were meticulously screened based on their relevance to our investigative criteria. Bias was assessed using quality assessments tools, including Quality in Prognosis Studies (QUIPS) and Newcastle-Ottawa Scale (NOS). Diverse datasets encompassing MCs prevalence, demographic influences, risk factors, cervical sagittal parameters, and surgical outcomes were extracted. Meta-analysis using both random and common effects model was used to synthesis the metadata.
From a total of 867 studies, 38 met inclusion criteria and underwent full-text assessment. The overall prevalence of cervical MCs was 26.0% (95% CI: 19.0%, 34.0%), with a predominance of type 2 MCs (15% ; 95% CI: 0.10%, 0.23%). There was no significant difference between MCs and non-MCs in terms of neck pain (OR:3.09; 95% CI: 0.81, 11.88) and radicular pain (OR: 1.44; 95% CI: 0.64, 3.25). The results indicated a significantly higher mean age in the MC group (MD: 1.69 years; 95% CI: 0.29 years, 3.08 years). Additionally, smokers had 1.21 times the odds (95% CI: 1.01, 1.45) of a higher risk of developing MCs compared to non-smokers. While most cervical sagittal parameters remained unaffected, the presence of MCs indicated no substantial variation in pain intensity. However, a significant finding was the lower Japanese Orthopaedic Association (JOA) scores observed in MC patients at the 3-month (MD: -0.34, 95% CI: -0.62, -0.07) and 6-month (MD: -0.40, 95% CI: -0.80, 0.00) postoperative periods, indicating a prolonged recovery phase.
This study found a predominant of type 2 MCs in the cervical spine. However, there was no significant mean difference between MCs and non-MC groups regarding neck pain and radicular pain. The results underscore the necessity for expansive, longitudinal research to elucidate the complexity of cervical MCs, particularly in surgical and postoperative contexts.
颈椎 Modic 改变（MCs）较为常见，但仍是一个研究较少的现象，尤其是关于其患病率、自然史、危险因素以及对手术结果的影响。本系统评价和荟萃分析旨在阐明颈椎 MCs 的多因素维度和临床意义。
根据 PRISMA 指南，使用 Medline（通过 PubMed）、EMBASE、Scopus 和 Web of Science 数据库，从各数据库的建立日期到 2023 年 9 月 4 日，全面系统地进行了检索。根据我们的调查标准，对所有确定的文章进行了仔细筛选。使用质量评估工具（包括预后研究质量评估工具[QUIPS]和纽卡斯尔-渥太华量表[NOS]）评估偏倚。提取了包括 MCs 患病率、人口统计学影响、危险因素、颈椎矢状参数和手术结果在内的各种数据集。使用随机和共同效应模型进行荟萃分析以综合元数据。
在总共 867 项研究中，有 38 项符合纳入标准并进行了全文评估。颈椎 MCs 的总体患病率为 26.0%（95%CI：19.0%，34.0%），其中 2 型 MCs 占主导地位（15%；95%CI：0.10%，0.23%）。MCs 组和非 MCs 组在颈部疼痛（OR：3.09；95%CI：0.81，11.88）和神经根性疼痛（OR：1.44；95%CI：0.64，3.25）方面无显著差异。结果表明，MC 组的平均年龄明显较高（MD：1.69 岁；95%CI：0.29 岁，3.08 岁）。此外，与非吸烟者相比，吸烟者发生 MCs 的风险增加 1.21 倍（95%CI：1.01，1.45）。虽然大多数颈椎矢状参数不受影响，但 MCs 的存在表明疼痛强度没有明显变化。然而，一个显著的发现是 MC 患者在术后 3 个月（MD：-0.34，95%CI：-0.62，-0.07）和 6 个月（MD：-0.40，95%CI：-0.80，0.00）的日本矫形协会（JOA）评分较低，这表明恢复期延长。
本研究发现颈椎 2 型 MCs 占主导地位。然而，MCs 组和非 MCs 组在颈部疼痛和神经根性疼痛方面的平均差异无统计学意义。结果强调需要进行广泛的、纵向的研究来阐明颈椎 MCs 的复杂性，特别是在手术和术后背景下。
