Course of Modic 1 six months after lumbar posterior osteosynthesis.

Abstract

STUDY DESIGN:

A prospective study was conducted to investigate the outcome of the Modic Type 1 inflammatory signal in magnetic resonance imaging (MRI) in 17 patients with chronic low back pain 6 months after instrumented posterior lumbar arthrodesis.

OBJECTIVE:

To assess the course of the inflammatory signal after stabilization of a painful intervertebral segment by posterior instrumentation alone visualized on MRI systematically performed 6 months after the operation.

SUMMARY OF BACKGROUND DATA:

In 1988, Modic and colleagues described three degenerative stages of vertebral endplates and subchondral bone. The inflammatory stage, or Stage 1, is correlated with substantial functional disability. According to these authors, Stage 1 lesions naturally transform into Stage 2, the fatty stage. In the literature, patients with Modic 1 signal tend to have good results after arthrodesis, better than those with Modic 2 lesions.

METHODS:

This study included 17 patients (average age, 46 years) who had experienced chronic low back pain more than 1 year and showed Modic 1 changes in MRI and disc narrowing on plain radiographs. Every patient underwent posterior screw-rod osteosynthesis and posterolateral arthrodesis. Disc disease had occurred subsequently to discectomy (n = 7), rapidly destructive disc disease (n = 5), or spondylolisthesis resulting from spondylolysis (n = 5). Clinical results were assessed according to a visual analog scale for pain, a functional disability score for the evaluation of patients with low back pain (Eiffel), and the validated French version of the self-administered Dallas quality-of-life test (DRAD).

RESULTS:

Systematic MRI at 6 months showed transformation from Modic 1 to Modic 0 (normal endplate signal) in 4 patients and transformation from Modic 1 to Modic 2 in the remaining 13 patients. Clinical evaluation was performed at 6 months (at the same time as the MRI) and at 1 year. In every patient, there was improvement in the visual analog score and the functional score, which remained stable at 1 year.

CONCLUSIONS:

According to the literature, most Modic 1 lesions change to become Stage 2 lesions in 18 to 24 months. In this study, 17 patients with Modic Type 1 signal had changes after 6 months. It appears that posterior osteosynthesis combined with posterolateral arthrodesis accelerates the course of Modic 1 lesions, probably by correcting mechanical instability.

• Authors: J M Vital, O Gille, V Pointillart, M Pedram, P Bacon, F Razanabola, C Schaelderle, S Azzouz
• Journal: Spine (Spine (Phila Pa 1976)) Vol. 28 Issue 7 Pg. 715-20; discussion 721 (Apr 01 2003) ISSN: 1528-1159 [Electronic] United States
• PMID: 12671361 (Publication Type: Clinical Trial, Journal Article)

Topics

• Adult
• Chronic Disease
• Diskectomy (adverse effects)
• Female
• Follow-Up Studies
• Humans
• Intervertebral Disc Displacement (complications, diagnostic imaging, surgery)
• Low Back Pain (diagnosis, etiology)
• Lumbar Vertebrae (pathology, surgery)
• Lumbosacral Region
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Osteogenesis (physiology)
• Pain Measurement
• Predictive Value of Tests
• Prospective Studies
• Quality of Life
• Radiography
• Spinal Fusion (adverse effects, methods)
• Spondylolisthesis (complications, diagnostic imaging, surgery)
• Treatment Outcome