Analysis of the Efficacy of Percutaneous Endoscopic Interlaminar Discectomy for Lumbar Disc Herniation with Different Types/Grades of Modic Changes

Abstract

Background

Percutaneous endoscopic interlaminar discectomy (PEID), one of the main techniques of spinal endoscopy, has achieved excellent results in treating lumbar disc herniation (LDH). However, its efficacy has not been systematically described in patients with LDH accompanied by Modic changes (MC).

Purpose

The purpose of this study was to observe the clinical efficacy of PEID treatment of LDH accompanied by MC.

Patients and Methods

A total of 207 patients who underwent PEID surgery for LDH were selected. According to the existence and type of MC on preoperative lumbar magnetic resonance images (MRI), they were divided into normal group (no MC, n=117), M1 group (MC I, n=23), and M2 group (MC II, n=67). According to the severity of MC, they were divided into MA group (grade A, n=45) and MBC group (grade B and C, n=45). The visual analog scale (VAS) score, Oswestry disability index (ODI) score, Disc height index (DHI), Lumbar lordosis angle (LL) and modified Macnab criteria were used to assess clinical outcomes.

Results

Postoperative back pain and leg pain VAS scores and ODI scores were significantly improved in all groups compared with preoperative scores. Patients with MC showed a deterioration in postoperative back pain VAS scores and ODI scores as time went by, and postoperative DHI decreased significantly compared with preoperative. Postoperative LL did not change significantly in each group. There was no significant difference in complications, recurrence rate and excellent rate between the groups.

Conclusion

Whether accompanied by MC or not, the efficacy of PEID for LDH was significant. However, postoperative back pain and functional status of patients with MC tend to deteriorate as time went by, especially those with type I or severe MC.

Keywords:

• Modic changes
• MC type
• MC grade
• percutaneous endoscopic interlaminar discectomy
• lumbar disc herniation
• low back pain

Abbreviations

PEID, Percutaneous endoscopic interlaminar discectomy; PTED, Percutaneous transforaminal endoscopic discectomy; LDH, Lumbar disc herniation; MC, Modic changes; MRI, Magnetic resonance imaging; VAS, Visual analog scale; ODI, Oswestry disability index; DHI, Disc height index; LL, Lumbar lordosis angle; Preop, Preoperation.

Data Sharing Statement

The data used to support the findings of this study are available from the corresponding author upon request.

Ethics Approval and Consent to Participate

This research was approved by the ethics committee of The First Affiliated Hospital of Harbin Medical University. The research was in compliance with the Helsinki Declaration. Written informed consent was obtained from all the participants. All procedures were performed in accordance with relevant guidelines.

Acknowledgments

We would like to thank all the participants in the study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The authors have received no external funding in order to support this project.