Skip to main content
SpringerLink
Log in

The influence of endplate (Modic) changes on clinical outcomes in lumbar spinal stenosis surgery: a Swiss prospective multicenter cohort study

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To investigate if the presence or absence of preoperative endplate Modic changes (MC) is predictive for clinical outcomes in degenerative lumbar spinal stenosis (DLSS) patients undergoing decompression-alone or decompression with instrumented fusion surgery.

Methods

Two hundred five patients were included and categorized into four groups; 102 patients into the decompression-alone group with MCs, 41 patients into the fusion group with MCs, 46 patients into the decompression-alone group without MCs, and 16 patients into the fusion group without MCs. Clinical outcome was quantified with changes in spinal stenosis measure (SSM) symptoms, SSM function, NRS pain, and EQ-5D-3L sum score over time (measured at baseline, 12-, 24-, and 36-month follow-up) and minimal clinically important difference (MCID) in SSM symptoms, SSM function, and NRS pain from baseline to 36-month follow-up. To investigate if possible effects of MCs had been modified or hidden by confounding variables, we used the group LASSO method to search for good prognostic models.

Results

There were no obvious differences in any of the clinical outcome measures between groups at baseline. At 12 months, most patients have improved in all outcomes and maintained improved conditions over time (no significant group differences). Between 70 and 90 percent of the patients maintained a clinically important improvement up to 36 months.

Conclusions

Endplate MCs have no significant influence on clinical outcome parameters in patients with lumbar spinal stenosis compared to patients without MCs, independent of the chosen surgical strategy. All patients benefitted from surgical therapy up to 36-month follow-up.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

DLSS:

Degenerative lumbar spinal stenosis

LSOS:

Lumbar Stenosis Outcome Study

References

  1. de Roos A, Kressel H, Spritzer C, Dalinka M (1987) MR imaging of marrow changes adjacent to end plates in degenerative lumbar disk disease. AJR Am J Roentgenol 149(3):531–534. https://doi.org/10.2214/ajr.149.3.531

    Article  PubMed  Google Scholar 

  2. Modic MT, Masaryk TJ, Ross JS, Carter JR (1988) Imaging of degenerative disk disease. Radiology 168(1):177–186. https://doi.org/10.1148/radiology.168.1.3289089

    Article  CAS  PubMed  Google Scholar 

  3. Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166(1 Pt 1):193–199. https://doi.org/10.1148/radiology.166.1.3336678

    Article  CAS  PubMed  Google Scholar 

  4. Zhang Y-H, Zhao C-Q, Jiang L-S, Chen X-D, Dai L-Y (2008) Modic changes: a systematic review of the literature. Eur Spine J 17(10):1289–1299. https://doi.org/10.1007/s00586-008-0758-y

    Article  PubMed  PubMed Central  Google Scholar 

  5. Albert HB, Briggs AM, Kent P, Byrhagen A, Hansen C, Kjaergaard K (2011) The prevalence of MRI-defined spinal pathoanatomies and their association with modic changes in individuals seeking care for low back pain. Eur Spine J 20(8):1355–1362. https://doi.org/10.1007/s00586-011-1794-6

    Article  PubMed  PubMed Central  Google Scholar 

  6. Jensen TS, Karppinen J, Sorensen JS, Niinimaki J, Leboeuf-Yde C (2008) Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J 17(11):1407–1422. https://doi.org/10.1007/s00586-008-0770-2

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mok FPS, Samartzis D, Karppinen J, Fong DYT, Luk KDK, Cheung KMC (2016) Modic changes of the lumbar spine: prevalence, risk factors, and association with disc degeneration and low back pain in a large-scale population-based cohort. Spine J 16(1):32–41. https://doi.org/10.1016/j.spinee.2015.09.060

    Article  PubMed  Google Scholar 

  8. Rahme R, Moussa R (2008) The modic vertebral endplate and marrow changes: pathologic significance and relation to low back pain and segmental instability of the lumbar spine. Am J Neuroradiol 29(5):838–842

    Article  CAS  Google Scholar 

  9. Lang P, Chafetz N, Genant HK, Morris JM (1990) Lumbar spinal fusion. Assessment of functional stability with magnetic resonance imaging. Spine (Phila Pa 1976) 15(6):581–588

    Article  CAS  Google Scholar 

  10. Braithwaite I, White J, Saifuddin A, Renton P, Taylor BA (1998) Vertebral end-plate (Modic) changes on lumbar spine MRI: correlation with pain reproduction at lumbar discography. Eur Spine J 7(5):363–368

    Article  CAS  Google Scholar 

  11. Jensen RK, Leboeuf-Yde C, Wedderkopp N, Sorensen JS, Jensen TS, Manniche C (2012) Is the development of Modic changes associated with clinical symptoms? A 14-month cohort study with MRI. Eur Spine J 21(11):2271–2279. https://doi.org/10.1007/s00586-012-2309-9

    Article  PubMed  PubMed Central  Google Scholar 

  12. Albert HB, Sorensen JS, Christensen BS, Manniche C (2013) Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy. Eur Spine J 22(4):697–707. https://doi.org/10.1007/s00586-013-2675-y

    Article  PubMed  PubMed Central  Google Scholar 

  13. Albert HB, Manniche C, Sorensen JS, Deleuran BW (2008) Antibiotic treatment in patients with low-back pain associated with Modic changes Type 1 (bone oedema): a pilot study. Br J Sports Med 42(12):969–973. https://doi.org/10.1136/bjsm.2008.050369

    Article  CAS  PubMed  Google Scholar 

  14. Cao P, Chen Z, Zheng Y, Wang Y, Jiang L, Yang Y, Zhuang C, Liang Y, Zheng T, Gong Y, Zhang X, Wu W, Qiu S (2014) Comparison of simple discectomy and instrumented posterior lumbar interbody fusion for treatment of lumbar disc herniation combined with Modic endplate changes. Chin Med J (Engl) 127(15):2789–2794

    Google Scholar 

  15. Ghodsi SM, Rouhani R, Abdollahzade S, Khadivi M, Faghih Jouibari M (2015) Frequency of vertebral endplate modic changes in patients with unstable lumbar spine and its effect on surgical outcome. Asian Spine J 9(5):737–740. https://doi.org/10.4184/asj.2015.9.5.737

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kwon YM, Chin DK, Jin BH, Kim KS, Cho YE, Kuh SU (2009) Long term efficacy of posterior lumbar interbody fusion with standard cages alone in lumbar disc diseases combined with modic changes. J Korean Neurosurg Soc 46(4):322–327. https://doi.org/10.3340/jkns.2009.46.4.322

    Article  PubMed  PubMed Central  Google Scholar 

  17. Rauschning W (1993) Pathoanatomy of lumbar disc degeneration and stenosis. Acta Orthop Scand Suppl 251:3–12

    Article  CAS  Google Scholar 

  18. Hayashi T, Daubs MD, Suzuki A, Scott TP, Phan KH, Ruangchainikom M, Takahashi S, Shiba K, Wang JC (2015) Motion characteristics and related factors of Modic changes in the lumbar spine. J Neurosurg Spine 22(5):511–517. https://doi.org/10.3171/2014.10.SPINE14496

    Article  PubMed  Google Scholar 

  19. Ohtori S, Yamashita M, Yamauchi K, Inoue G, Koshi T, Suzuki M, Orita S, Eguchi Y, Ochiai N, Kishida S, Takaso M, Aoki Y, Ishikawa T, Arai G, Miyagi M, Kamoda H, Nakamura J, Takahashi K (2010) Low back pain after lumbar discectomy in patients showing endplate modic type 1 change. Spine (Phila Pa 1976) 35(13):E596–600. https://doi.org/10.1097/brs.0b013e3181cd2cb8

    Article  Google Scholar 

  20. Ulrich NH, Burgstaller JM, Gravestock I, Pichierri G, Wertli MM, Steurer J, Farshad M, Porchet F (2019) Outcome of unilateral versus standard open midline approach for bilateral decompression in lumbar spinal stenosis: is “over the top” really better? A Swiss prospective multicenter cohort study. J Neurosurg Spine. https://doi.org/10.3171/2019.2.spine181309

    Article  PubMed  Google Scholar 

  21. Ulrich NH, Burgstaller JM, Pichierri G, Wertli MM, Farshad M, Porchet F, Steurer J, Held U, Grp LS (2017) Decompression surgery alone versus decompression plus fusion in symptomatic lumbar spinal stenosis. Spine 42(18):E1077–E1086. https://doi.org/10.1097/Brs.0000000000002068

    Article  PubMed  Google Scholar 

  22. Burgstaller JM, Wertli MM, Steurer J, Kessels AG, Held U, Gramke H-F, Group LS (2017) The influence of pre-and postoperative fear avoidance beliefs on postoperative pain and disability in patients with lumbar spinal stenosis: analysis of the lumbar spinal outcome study (LSOS) data. Spine 42(7):E425–E432

    Article  Google Scholar 

  23. Steurer J, Nydegger A, Held U, Brunner F, Hodler J, Porchet F, Min K, Mannion AF, Michel B, Collaboration LR (2010) LumbSten: the lumbar spinal stenosis outcome study. Bmc Musculoskel Dis. https://doi.org/10.1186/1471-2474-11-254

    Article  Google Scholar 

  24. Stucki G, Liang MH, Fossel AH, Katz JN (1995) Relative responsiveness of condition-specific and generic health status measures in degenerative lumbar spinal stenosis. J Clin Epidemiol 48(11):1369–1378

    Article  CAS  Google Scholar 

  25. Stucki G, Daltroy L, Liang MH, Lipson SJ, Fossel AH, Katz JN (1996) Measurement properties of a self-administered outcome measure in lumbar spinal stenosis. Spine (Phila Pa 1976) 21(7):796–803

    Article  CAS  Google Scholar 

  26. Hinz A, Klaiberg A, Brahler E, Konig HH (2006) The quality of life questionnaire EQ-5D: modelling and norm values for the general population. Psychother Psychosom Med Psychol 56(2):42–48. https://doi.org/10.1055/s-2005-867061

    Article  PubMed  Google Scholar 

  27. Ostelo RWJG, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, Bouter LM, de Vet HC (2008) Interpreting change scores for pain and functional status in low back pain—towards international consensus regarding minimal important change. Spine 33(1):90–94

    Article  Google Scholar 

  28. Yang Y, Zou H (2015) A fast unified algorithm for solving group-lasso penalize learning problems. Stat Comput 25(6):1129–1141. https://doi.org/10.1007/s11222-014-9498-5

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank the Baugarten Foundation, the Helmut Horten Foundation, the Pfizer-Foundation for geriatrics and research in geriatrics, the Symphasis Charitable Foundation, and the OPO Foundation for their support.

Author information

Author notes

  1. Nils H. Ulrich and Jakob M. Burgstaller have contributed equally to this work.

Authors and Affiliations

  1. Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland

    Nils H. Ulrich, Jakob M. Burgstaller, Isaac Gravestock, Giuseppe Pichierri, Maria M. Wertli & Johann Steurer

  2. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Sebastian Winklhofer

  3. Department of Orthopedics and Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland

    François Porchet

  4. Division of General Internal Medicine, Bern University Hospital, Bern University, Bern, Switzerland

    Maria M. Wertli

  5. University Spine Centre Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland

    Nils H. Ulrich & Mazda Farshad

Authors
  1. Nils H. Ulrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jakob M. Burgstaller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Isaac Gravestock
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sebastian Winklhofer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. François Porchet
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giuseppe Pichierri
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Maria M. Wertli
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Johann Steurer
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mazda Farshad
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

the LSOS Study Group

Corresponding author

Correspondence to Nils H. Ulrich.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 583 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ulrich, N.H., Burgstaller, J.M., Gravestock, I. et al. The influence of endplate (Modic) changes on clinical outcomes in lumbar spinal stenosis surgery: a Swiss prospective multicenter cohort study. Eur Spine J 29, 2205–2214 (2020). https://doi.org/10.1007/s00586-020-06364-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-020-06364-0

Keywords

Search

Navigation