Kawaguchi Kenichi, Saiwai Hirokazu, Kobayakawa Kazu, Tarukado Kiyoshi, Yokota Kazuya, Harimaya Katsumi, Kato Go, Nakashima Yasuharu
Kyushu University, Fukuoka, Japan.
Kyushu University Beppu Hospital, Beppu, Japan.
Eur Spine J. 2025 Jul 29. doi: 10.1007/s00586-025-09171-7.
The impact of endplate changes, such as Modic changes (MCs), on symptoms following discectomy remains uncertain. This study aimed to investigate the postoperative progression of MCs and bony endplate defects after discectomy for lumbar disc herniation (LDH) and to elucidate its association with clinical outcomes.
A total of 247 patients who underwent microscopic discectomy were included. The natural progression of MCs and bony endplate defects at the operated level were assessed using magnetic resonance imaging. Clinical outcomes were evaluated using a visual analog scale (VAS) and the Roland-Morris Disability Questionnaire. The study examined the progression of endplate changes and their impact on clinical outcomes, with a focus on the type of postoperative MC.
The natural progression of postoperative MCs was varied, with MCs coexisting with bony endplate defects (p < 0.001). Persistent or converted type 1-related MCs were more likely to exacerbate pre-existing signal changes at one year and were associated with higher VAS scores for low back pain (LBP) compared to type 2 MCs (p < 0.001). Patients with type 1-related MCs (β: 0.429, p < 0.001) and preoperative LBP (β: 0.215, p = 0.025) were closely associated with residual LBP at one year or more.
In patients with baseline signal changes in subchondral bone marrow, the presence of type 1 MCs was more likely to promote the increase of MCs than type 2. Furthermore, the presence of type 1 MCs may predict residual postoperative LBP, suggesting that bone marrow signal changes are more strongly associated with clinical symptoms than morphological changes in bony endplates in patients with LDH.
终板改变，如Modic改变（MCs），对椎间盘切除术后症状的影响仍不确定。本研究旨在调查腰椎间盘突出症（LDH）椎间盘切除术后MCs和骨终板缺损的术后进展情况，并阐明其与临床结果的关联。
共纳入247例行显微椎间盘切除术的患者。使用磁共振成像评估手术节段MCs和骨终板缺损的自然进展情况。使用视觉模拟量表（VAS）和罗兰-莫里斯残疾问卷评估临床结果。本研究考察了终板改变的进展及其对临床结果的影响，重点关注术后MC的类型。
术后MCs的自然进展情况各不相同，MCs与骨终板缺损并存（p < 0.001）。与2型MCs相比，持续或转变的1型相关MCs在1年时更有可能加剧先前存在的信号改变，并且与更高的下腰痛（LBP）VAS评分相关（p < 0.001）。1型相关MCs患者（β：0.429，p < 0.001）和术前LBP患者（β：0.215，p = 0.025）与1年及以上的残余LBP密切相关。
在软骨下骨髓有基线信号改变的患者中，1型MCs的存在比2型更有可能促进MCs的增加。此外，1型MCs的存在可能预示术后残余LBP，这表明在LDH患者中，骨髓信号改变比骨终板形态改变与临床症状的相关性更强。
