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Is discectomy effective for treating low back pain in patients with lumbar disc herniation and Modic changes? A systematic review and meta-analysis of cohort studies

  • Sunqi Nian
    Affiliations
    The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650500, P.R. China
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  • Na Li
    Affiliations
    Department of Anesthesiology, 920th Hospital of the Joint Logistics Support Force, No. 212, Daguan Road, Kunming, Yunnan, China
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  • Fanyi Kong
    Affiliations
    Department of Neurology, Affiliated Hospital of Yunnan University, No. 176, Qingnian Rd, Kunming, 650021, Yunnan Province, China
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  • Sheng Lu
    Affiliations
    The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650500, P.R. China

    Department of Orthopedics, The First People's Hospital of Yunnan Province, No. 157, Jinbi Road, Kunming, Yunnan, China
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  • Jiayu Chen
    Correspondence
    Corresponding author: The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650500, P.R. China. Phone: +8618988078116.
    Affiliations
    The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650500, P.R. China

    Department of Orthopedics, The First People's Hospital of Yunnan Province, No. 157, Jinbi Road, Kunming, Yunnan, China
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Published:October 31, 2022DOI:https://doi.org/10.1016/j.spinee.2022.10.008

      Abstract

      BACKGROUND CONTEXT

      Previous low-quality evidence has suggested preoperative Modic changes (MC) showed a trend toward less improvement in low back pain in patients with lumbar disc herniation (LDH) undergoing discectomy. However, a recent meta-analysis concluded that the presence of preoperative MC did not significantly impact clinical outcomes following lumbar discectomy.

      PURPOSE

      To compare low back pain and functional outcomes of patients after discectomy for LDH with preoperative MC.

      STUDY DESIGN

      Systematic review and meta-analysis of cohort studies.

      METHODS

      This comprehensive systematic review and meta-analysis used English-language articles identified through searches using Pubmed, Web of Science, Embase, and Cochrane library until August 2022. The included studies identified publications that concentrated on the patients suffering from LDH with different preoperative MCs treated by discectomy. The Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) were the two main metrics to evaluate outcomes.

      RESULTS

      A series of 2,299 LDH patients with a definitive type of MC were included in four retrospective and five prospective studies. Overall, there is moderate to high quality evidence suggesting no significant difference between normal and MC groups for pain outcomes as well as normal and Modic type 2 groups in terms of pain or functional outcomes at one or two-year follow up. There are less functional outcomes in LDH patients with preoperative MC compared with no MC at 2-year follow up and showed no significant difference at 1-year follow-up. However, above all results may due to heterogeneity. Subgroup analysis revealed that only Modic type 1 showed statistically lower functional scores (mean difference in ODI scores range from 0 to 100) compared with Modic type 2 or compared with no MC at 2-year follow-up and showed no significant difference at 1-year follow-up (MC1 vs. MC0, p=.24, MD= -2.70; 95% CI, -7.15 to 1.76 for 1-year;p<.00001, MD= -7.92; 95% CI, -11.19 to -4.66 for 2 years. MC1 vs. MC2, p=.58, MD= -1.29; 95% CI, -5.83 to 3.25 for 1-year;p<.0001, MD= -6.77; 95% CI, -9.94 to -3.61 for 2 years).

      CONCLUSIONS

      These data suggest LDH patients with or without preoperative MCs show a similar improvement of low back pain at 1 and 2-year follow-up and functional scores after discectomy at one-year follow-up. LDH patients with preoperative Modic type 1 are associated with worse functional status after discectomy at 2-year follow-up. However, high-quality randomized controlled trials and prospective cohort studies which focus on analyzing the risk and confounding factors are lacking.

      Keywords

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