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Modic type I changes and recovery of back pain after lumbar microdiscectomy

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Abstract

Purpose

To investigate whether the presence of Modic changes type I (MC I) found on preoperative MRI scans represent a risk factor for persistent back pain 12 months after surgery amongst patients operated for lumbar disc herniation.

Methods

Cohort study of 178 consecutive patients operated with lumbar microdiscectomy. Preoperative MRI scans were evaluated by two independent neuroradiologists. Primary outcome measure was the visual analogue scale (VAS) for back pain. Secondary outcome measures were; VAS for leg pain, physical function (Oswestry Disability Index), and health-related quality of life (EQ-5D), self-reported benefit of the operation and employment status. The presence of MC I was used as exposition variable and adjusted for other risk factors in multivariate analyses.

Results

The Modic classification showed a high inter-observer reproducibility. Patients with MC I had less improvement of back pain 12 months after surgery, compared to those who had no or other types of MC, but this negative association no longer showed statistical significance when adjusted for smoking, which remained the only independent risk factor for persistent back pain.

Conclusions

Patients with preoperative MC I can expect less but still significant improvement of back pain 1 year after microdiscectomy, but not if they smoke cigarettes.

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Conflict of interest

None of the authors has any potential conflict of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital of North-Norway, 9038, Tromsø, Norway

    Andreas Sørlie, Roar Kloster & Tore K. Solberg

  2. The Norwegian Registry for Spine Surgery (NORspine), SKDE, North-Norway Regional Health Authority, Tromsø, Norway

    Andreas Sørlie, Øystein P. Nygaard & Tore K. Solberg

  3. Department of Radiology, University Hospital of St. Olav, Trondheim, Norway

    Viggo Moholdt & Kjell Arne Kvistad

  4. National Centre of Spinal Disorders and Department of Neurosurgery, University Hospital of St. Olav, Trondheim, Norway

    Øystein P. Nygaard

  5. Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway

    Øystein P. Nygaard

  6. Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway

    Tor Ingebrigtsen

  7. Department of Rehabilitation, University Hospital of North-Norway, Tromsø, Norway

    Trond Iversen

Authors
  1. Andreas Sørlie
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  2. Viggo Moholdt
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  3. Kjell Arne Kvistad
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  4. Øystein P. Nygaard
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  5. Tor Ingebrigtsen
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  6. Trond Iversen
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  7. Roar Kloster
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  8. Tore K. Solberg
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Correspondence to Andreas Sørlie.

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Sørlie, A., Moholdt, V., Kvistad, K.A. et al. Modic type I changes and recovery of back pain after lumbar microdiscectomy. Eur Spine J 21, 2252–2258 (2012). https://doi.org/10.1007/s00586-012-2419-4

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  • DOI: https://doi.org/10.1007/s00586-012-2419-4

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