Early Endoscopic Discectomy in Preventing Degenerative Spinal Changes in Patients With Lumbar Disc Herniation.

In this study, we compare the outcomes of two patients with similar spinal pathologies who chose different treatment options. The first case involves a 38-year-old female with significant lumbar disc herniation and associated degenerative spinal changes, including type I Modic changes. She presented with sciatica and, after conservative treatments failed, underwent an endoscopic discectomy. This intervention led to a marked improvement in her pain and functional status, along with a partial resolution of the Modic changes and a decrease in multifidus atrophy and fatty infiltration, on her follow-up MRI. In the second case, we discuss a 33-year-old patient with a large disc herniation. Despite three years of conservative management, she developed Modic changes and sclerosis in the adjacent vertebral endplates and a worsening of multifidus atrophy and fatty infiltration. This report supports the consideration of early minimally invasive discectomy for young patients who do not benefit from conservative treatment, as a means to prevent the progression of degenerative spinal changes.