Research progress on the influence of Modic changes on lumbar interbody fusion and its treatment measure_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIAO Yang ,  YANG Xi

Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding?author：

YANG Xi, Email: Formosa88@163.com

Keywords：

Lumbar; Modic changes; lumbar interbody fusion; treatment measure

DOI：

10.7507/1002-1892.202302007

Video：

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Objective To review the research progress of Modic changes and its influence on lumbar interbody fusion. Methods The domestic and foreign literature related to Modic changes and its influence on lumbar interbody fusion was extensively reviewed. The etiology of Modic changes was summarized, and the treatment measures of Modic changes on lumbar interbody fusion were discussed. Results The etiology of Modic changes is not clear, which may be related to mechanical factors, autoimmune factors, low toxic infection factors, and genetic factors. Modic changes may lead to fusion failure and cage subsidence after lumbar interbody fusion. Preoperative evaluation of endplate sclerosis, reduction of iatrogenic endplate injury, fine operating of intervertebral space, management of osteoporosis, and selection of appropriate cage can prevent or reduce fusion failure or cage subsidence. Conclusion Modic changes may lead to fusion failure and cage subsidence after lumbar interbody fusion, and active perioperative intervention of Modic changes is helpful to improve the clinical prognosis.

Citation： XIAO Yang, YANG Xi. Research progress on the influence of Modic changes on lumbar interbody fusion and its treatment measure. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(8): 1026-1030. doi: 10.7507/1002-1892.202302007 Copy

1.	唐少龍, 葉招明, 黃慶華, 等. 腰椎終板Modic改變與腰椎退變的相關性研究. 臨床骨科雜志, 2015, 18(4): 394-397.
2.	Mostofi K, Moghaddam BG, Peyravi M. Late appearance of low back pain relating to Modic change after lumbar discectomy. J Craniovertebr Junction Spine, 2018, 9(2): 93-95.
3.	何江濤, 何姝, 付能高, 等. 單側內固定椎間融合術治療伴Modic改變的腰椎間盤突出癥早期療效. 臨床骨科雜志, 2015, 18(5): 556-559.
4.	Jensen TS, Karppinen J, Sorensen JS, et al. Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J, 2008, 17(11): 1407-1422.
5.	Kanna RM, Shanmuganathan R, Rajagopalan VR, et al. Prevalence, patterns, and genetic association analysis of Modic vertebral endplate changes. Asian Spine J, 2017, 11(4): 594-600.
6.	Applebaum A, Nessim A, Cho W. Modic change: An emerging complication in the aging population. Clin Spine Surg, 2022, 35(1): 12-17.
7.	Dudli S, Fields AJ, Samartzis D, et al. Pathobiology of Modic changes. Eur Spine J, 2016, 25(11): 3723-3734.
8.	Dudli S, Liebenberg E, Magnitsky S, et al. Propionibacterium acnes infected intervertebral discs cause vertebral bone marrow lesions consistent with Modic changes. J Orthop Res, 2016, 34(8): 1447-1455.
9.	Mu X, Peng W, Yu C, et al. Modic changes of the lumbar spine-their association with the lumbar sagittal parameters: A retrospective imaging study. J Orthop Surg Res, 2020, 15(1): 220.
10.	Modic MT, Masaryk TJ, Ross JS, et al. Imaging of degenerative disk disease. Radiology, 1988, 168(1): 177-186.
11.	Modic MT, Steinberg PM, Ross JS, et al. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology, 1988, 166(1 Pt 1): 193-199.
12.	Zhu J, Wu H, Chen Y, et al. The correlation between the change of Hounsfield units value and Modic changes in the lumbar vertebral endplate. BMC Musculoskelet Disord, 2021, 22(1): 509.
13.	Teichtahl AJ, Urquhart DM, Wang Y, et al. Lumbar disc degeneration is associated with modic change and high paraspinal fat content-a 3.0T magnetic resonance imaging study. BMC Musculoskelet Disord, 2016, 17(1): 439.
14.	?zcan-Ek?i EE, Yayla A, Orhun ?, et al. Is the distribution pattern of Modic changes in vertebral end-plates associated with the severity of intervertebral disc degeneration?: A cross-sectional analysis of 527 caucasians. World Neurosurg, 2021, 150: e298-e304.
15.	Xiao L, Ni C, Shi J, et al. Analysis of correlation between vertebral endplate change and lumbar disc degeneration. Med Sci Monit, 2017, 23: 4932-4938.
16.	Saukkonen J, M??tt? J, Oura P, et al. Association between Modic changes and low back pain in middle age: A Northern Finland birth cohort study. Spine (Phila Pa 1976), 2020, 45(19): 1360-1367.
17.	Teraguchi M, Hashizume H, Oka H, et al. Detailed subphenotyping of lumbar Modic changes and their association with low back pain in a large population-based study: The Wakayama spine study. Pain Ther, 2022, 11(1): 57-71.
18.	Conger A, Schuster NM, Cheng DS, et al. The effectiveness of intraosseous basivertebral nerve radiofrequency neurotomy for the treatment of chronic low back pain in patients with Modic changes: A systematic review. Pain Med, 2021, 22(5): 1039-1054.
19.	Han?mo?lu H, ?evik S, Y?lmaz H, et al. Effects of Modic type 1 changes in the vertebrae on low back pain. World Neurosurg, 2019, 121: e426-e432.
20.	Lan M, Ou Y, Wang C, et al. Patients with Modic type 2 change have a severe radiographic representation in the process of lumbar degeneration: a retrospective imaging study. J Orthop Surg Res, 2019, 14(1): 298.
21.	Wu ZM, Ji XQ, Lian K, et al. Analysis of the relationship between Modic Change and spinopelvic parameters in the sagittal plane. Med Sci Monit, 2020, 26: e919667.
22.	Mu X, Yu C, Kim SW, et al. Correlation of Modic changes with sagittal lumbopelvic parameters. J Pain Res, 2021, 14: 3877-3885.
23.	Kwon YM, Chin DK, Jin BH, et al. Long term efficacy of posterior lumbar interbody fusion with standard cages alone in lumbar disc diseases combined with Modic changes. J Korean Neurosurg Soc, 2009, 46(4): 322-327.
24.	Li H, Chen S, Wei HY, et al. Type 2 sclerotic Modic change affect fusion result in patients undergoing PLIF with pedicle screw instrumentation: a retrospective study. BMC Musculoskelet Disord, 2021, 22(1): 598.
25.	Wu HL, Ding WY, Shen Y, et al. Prevalence of vertebral endplate modic changes in degenerative lumbar scoliosis and its associated factors analysis. Spine (Phila Pa 1976), 2012, 37(23): 1958-1964.
26.	Liu J, Huang B, Hao L, et al. Association between Modic changes and endplate sclerosis: Evidence from a clinical radiology study and a rabbit model. J Orthop Translat, 2018, 16: 71-77.
27.	Sun C, Wang H, Jiang J, et al. The pathology of type Ⅱ Modic changes: Fat deposition or osteosclerosis? A study using CT scan. Biomed Res Int, 2018, 2018: 6853720.
28.	周興, 陸艷青, 彭建平, 等. TNF-α對人骨髓間充質干細胞sncRNAs表達的調控研究. 中國臨床新醫學, 2022, 15(5): 388-394.
29.	馬輝. Modic改變對退行性腰椎間盤疾病后路融合手術療效影響的分析. 廣州: 廣州中醫藥大學, 2015.
30.	王牧一, 徐亮, 邱勇, 等. Modic改變對腰椎經椎間孔椎間融合效果和融合器沉降的影響. 中華醫學雜志, 2019, 99(47): 3703-3709.
31.	Liu J, Ding W, Yang D, et al. Modic changes associated with endplate sclerosis can prevent cage subsidence in oblique lumbar interbody fusion (OLIF) stand-alone. World Neurosurg, 2020, 138: e160-e168..Liu J, Ding W, Yang D, et al. Modic changes associated with endplate sclerosis can prevent cage subsidence in oblique lumbar interbody fusion (OLIF) stand-alone. World Neurosurg, 2020, 138: e160-e168.
32.	Zavras AG, Federico V, Nolte MT, et al. Risk factors for subsidence following anterior lumbar interbody fusion. Global Spine J, 2022.
33.	Divi SN, Goyal DKC, Galetta MS, et al. How does body mass index influence outcomes in patients after lumbar fusion? Spine (Phila Pa 1976), 2020, 45(8): 555-561.
34.	Mattei TA, Rehman AA, Teles AR, et al. The ‘Lumbar Fusion Outcome Score’ (LUFOS): a new practical and surgically oriented grading system for preoperative prediction of surgical outcomes after lumbar spinal fusion in patients with degenerative disc disease and refractory chronic axial low back pain. Neurosurg Rev, 2017, 40(1): 67-81.
35.	Ji C, Yu S, Yan N, et al. Risk factors for subsidence of titanium mesh cage following single-level anterior cervical corpectomy and fusion. BMC Musculoskelet Disord, 2020, 21(1): 32.
36.	Crockett MT, Kelly BS, van Baarsel S, et al. Modic type 1 vertebral endplate changes: Injury, inflammation, or infection? AJR Am J Roentgenol, 2017, 209(1): 167-170.
37.	李琛, 孫崇毅. 椎間融合術后Modic改變對預后的影響及其預防與治療研究進展. 脊柱外科雜志, 2021, 19(6): 424-427.
38.	禹名卉, 趙彥濤, 衷鴻賓, 等. 骨形態發生蛋白2在腰椎融合術中應用的效果與并發癥. 中國骨與關節雜志, 2017, 6(3): 228-231.
39.	Nourian AA, Harrington J, Pulido PA, et al. Fusion rates of lateral lumbar interbody fusion using recombinant human bone morphogenetic protein-2. Global Spine J, 2019, 9(4): 398-402.
40.	吳楠. Modic改變與骨質疏松及下腰痛相關性分析. 蚌埠: 蚌埠醫學院, 2021.
41.	Yu Y, Robinson DL, Ackland DC, et al. Influence of the geometric and material properties of lumbar endplate on lumbar interbody fusion failure: a systematic review. J Orthop Surg Res, 2022, 17(1): 224.
42.	趙龍, 曾建成, 謝天航, 等. 腰椎椎間融合術后椎間融合器沉降的研究進展. 中國修復重建外科雜志, 2021, 35(8): 1063-1067.
43.	楊曦, 宋躍明, 孔清泉, 等. 納米羥基磷灰石/聚酰胺66椎間融合器植骨融合治療下腰椎退變性疾病的近期療效. 中國修復重建外科雜志, 2012, 26(12): 1425-1429.
44.	Lee JH, Kim SK, Kang SS, et al. A long-term follow-up, multicenter, comparative study of the radiologic, and clinical results between a CaO-SiO₂-P₂O₅-B₂O₃ bioactive glass ceramics (BGS-7) intervertebral spacer and titanium cage in 1-level posterior lumbar interbody fusion. Clin Spine Surg, 2020, 33(7): E322-E329.
45.	楊漢立, 鐘遠鳴, 何啟斌, 等. 納米羥基磷灰石與聚醚醚酮椎間融合器的比較. 中國矯形外科雜志, 2022, 30(16): 1473-1477.
46.	王彥金, 周英杰, 柴旭斌, 等. 3D打印多孔鈦合金椎間融合器與聚醚醚酮椎間融合器在后路腰椎椎間融合術中的應用研究. 中國修復重建外科雜志, 2022, 36(9): 1126-1131.

1. 唐少龍, 葉招明, 黃慶華, 等. 腰椎終板Modic改變與腰椎退變的相關性研究. 臨床骨科雜志, 2015, 18(4): 394-397.
2. Mostofi K, Moghaddam BG, Peyravi M. Late appearance of low back pain relating to Modic change after lumbar discectomy. J Craniovertebr Junction Spine, 2018, 9(2): 93-95.
3. 何江濤, 何姝, 付能高, 等. 單側內固定椎間融合術治療伴Modic改變的腰椎間盤突出癥早期療效. 臨床骨科雜志, 2015, 18(5): 556-559.
4. Jensen TS, Karppinen J, Sorensen JS, et al. Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J, 2008, 17(11): 1407-1422.
5. Kanna RM, Shanmuganathan R, Rajagopalan VR, et al. Prevalence, patterns, and genetic association analysis of Modic vertebral endplate changes. Asian Spine J, 2017, 11(4): 594-600.
6. Applebaum A, Nessim A, Cho W. Modic change: An emerging complication in the aging population. Clin Spine Surg, 2022, 35(1): 12-17.
7. Dudli S, Fields AJ, Samartzis D, et al. Pathobiology of Modic changes. Eur Spine J, 2016, 25(11): 3723-3734.
8. Dudli S, Liebenberg E, Magnitsky S, et al. Propionibacterium acnes infected intervertebral discs cause vertebral bone marrow lesions consistent with Modic changes. J Orthop Res, 2016, 34(8): 1447-1455.
9. Mu X, Peng W, Yu C, et al. Modic changes of the lumbar spine-their association with the lumbar sagittal parameters: A retrospective imaging study. J Orthop Surg Res, 2020, 15(1): 220.
10. Modic MT, Masaryk TJ, Ross JS, et al. Imaging of degenerative disk disease. Radiology, 1988, 168(1): 177-186.
11. Modic MT, Steinberg PM, Ross JS, et al. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology, 1988, 166(1 Pt 1): 193-199.
12. Zhu J, Wu H, Chen Y, et al. The correlation between the change of Hounsfield units value and Modic changes in the lumbar vertebral endplate. BMC Musculoskelet Disord, 2021, 22(1): 509.
13. Teichtahl AJ, Urquhart DM, Wang Y, et al. Lumbar disc degeneration is associated with modic change and high paraspinal fat content-a 3.0T magnetic resonance imaging study. BMC Musculoskelet Disord, 2016, 17(1): 439.
14. ?zcan-Ek?i EE, Yayla A, Orhun ?, et al. Is the distribution pattern of Modic changes in vertebral end-plates associated with the severity of intervertebral disc degeneration?: A cross-sectional analysis of 527 caucasians. World Neurosurg, 2021, 150: e298-e304.
15. Xiao L, Ni C, Shi J, et al. Analysis of correlation between vertebral endplate change and lumbar disc degeneration. Med Sci Monit, 2017, 23: 4932-4938.
16. Saukkonen J, M??tt? J, Oura P, et al. Association between Modic changes and low back pain in middle age: A Northern Finland birth cohort study. Spine (Phila Pa 1976), 2020, 45(19): 1360-1367.
17. Teraguchi M, Hashizume H, Oka H, et al. Detailed subphenotyping of lumbar Modic changes and their association with low back pain in a large population-based study: The Wakayama spine study. Pain Ther, 2022, 11(1): 57-71.
18. Conger A, Schuster NM, Cheng DS, et al. The effectiveness of intraosseous basivertebral nerve radiofrequency neurotomy for the treatment of chronic low back pain in patients with Modic changes: A systematic review. Pain Med, 2021, 22(5): 1039-1054.
19. Han?mo?lu H, ?evik S, Y?lmaz H, et al. Effects of Modic type 1 changes in the vertebrae on low back pain. World Neurosurg, 2019, 121: e426-e432.
20. Lan M, Ou Y, Wang C, et al. Patients with Modic type 2 change have a severe radiographic representation in the process of lumbar degeneration: a retrospective imaging study. J Orthop Surg Res, 2019, 14(1): 298.
21. Wu ZM, Ji XQ, Lian K, et al. Analysis of the relationship between Modic Change and spinopelvic parameters in the sagittal plane. Med Sci Monit, 2020, 26: e919667.
22. Mu X, Yu C, Kim SW, et al. Correlation of Modic changes with sagittal lumbopelvic parameters. J Pain Res, 2021, 14: 3877-3885.
23. Kwon YM, Chin DK, Jin BH, et al. Long term efficacy of posterior lumbar interbody fusion with standard cages alone in lumbar disc diseases combined with Modic changes. J Korean Neurosurg Soc, 2009, 46(4): 322-327.
24. Li H, Chen S, Wei HY, et al. Type 2 sclerotic Modic change affect fusion result in patients undergoing PLIF with pedicle screw instrumentation: a retrospective study. BMC Musculoskelet Disord, 2021, 22(1): 598.
25. Wu HL, Ding WY, Shen Y, et al. Prevalence of vertebral endplate modic changes in degenerative lumbar scoliosis and its associated factors analysis. Spine (Phila Pa 1976), 2012, 37(23): 1958-1964.
26. Liu J, Huang B, Hao L, et al. Association between Modic changes and endplate sclerosis: Evidence from a clinical radiology study and a rabbit model. J Orthop Translat, 2018, 16: 71-77.
27. Sun C, Wang H, Jiang J, et al. The pathology of type Ⅱ Modic changes: Fat deposition or osteosclerosis? A study using CT scan. Biomed Res Int, 2018, 2018: 6853720.
28. 周興, 陸艷青, 彭建平, 等. TNF-α對人骨髓間充質干細胞sncRNAs表達的調控研究. 中國臨床新醫學, 2022, 15(5): 388-394.
29. 馬輝. Modic改變對退行性腰椎間盤疾病后路融合手術療效影響的分析. 廣州: 廣州中醫藥大學, 2015.
30. 王牧一, 徐亮, 邱勇, 等. Modic改變對腰椎經椎間孔椎間融合效果和融合器沉降的影響. 中華醫學雜志, 2019, 99(47): 3703-3709.
31. Liu J, Ding W, Yang D, et al. Modic changes associated with endplate sclerosis can prevent cage subsidence in oblique lumbar interbody fusion (OLIF) stand-alone. World Neurosurg, 2020, 138: e160-e168..Liu J, Ding W, Yang D, et al. Modic changes associated with endplate sclerosis can prevent cage subsidence in oblique lumbar interbody fusion (OLIF) stand-alone. World Neurosurg, 2020, 138: e160-e168.
32. Zavras AG, Federico V, Nolte MT, et al. Risk factors for subsidence following anterior lumbar interbody fusion. Global Spine J, 2022.
33. Divi SN, Goyal DKC, Galetta MS, et al. How does body mass index influence outcomes in patients after lumbar fusion? Spine (Phila Pa 1976), 2020, 45(8): 555-561.
34. Mattei TA, Rehman AA, Teles AR, et al. The ‘Lumbar Fusion Outcome Score’ (LUFOS): a new practical and surgically oriented grading system for preoperative prediction of surgical outcomes after lumbar spinal fusion in patients with degenerative disc disease and refractory chronic axial low back pain. Neurosurg Rev, 2017, 40(1): 67-81.
35. Ji C, Yu S, Yan N, et al. Risk factors for subsidence of titanium mesh cage following single-level anterior cervical corpectomy and fusion. BMC Musculoskelet Disord, 2020, 21(1): 32.
36. Crockett MT, Kelly BS, van Baarsel S, et al. Modic type 1 vertebral endplate changes: Injury, inflammation, or infection? AJR Am J Roentgenol, 2017, 209(1): 167-170.
37. 李琛, 孫崇毅. 椎間融合術后Modic改變對預后的影響及其預防與治療研究進展. 脊柱外科雜志, 2021, 19(6): 424-427.
38. 禹名卉, 趙彥濤, 衷鴻賓, 等. 骨形態發生蛋白2在腰椎融合術中應用的效果與并發癥. 中國骨與關節雜志, 2017, 6(3): 228-231.
39. Nourian AA, Harrington J, Pulido PA, et al. Fusion rates of lateral lumbar interbody fusion using recombinant human bone morphogenetic protein-2. Global Spine J, 2019, 9(4): 398-402.
40. 吳楠. Modic改變與骨質疏松及下腰痛相關性分析. 蚌埠: 蚌埠醫學院, 2021.
41. Yu Y, Robinson DL, Ackland DC, et al. Influence of the geometric and material properties of lumbar endplate on lumbar interbody fusion failure: a systematic review. J Orthop Surg Res, 2022, 17(1): 224.
42. 趙龍, 曾建成, 謝天航, 等. 腰椎椎間融合術后椎間融合器沉降的研究進展. 中國修復重建外科雜志, 2021, 35(8): 1063-1067.
43. 楊曦, 宋躍明, 孔清泉, 等. 納米羥基磷灰石/聚酰胺66椎間融合器植骨融合治療下腰椎退變性疾病的近期療效. 中國修復重建外科雜志, 2012, 26(12): 1425-1429.
44. Lee JH, Kim SK, Kang SS, et al. A long-term follow-up, multicenter, comparative study of the radiologic, and clinical results between a CaO-SiO₂-P₂O₅-B₂O₃ bioactive glass ceramics (BGS-7) intervertebral spacer and titanium cage in 1-level posterior lumbar interbody fusion. Clin Spine Surg, 2020, 33(7): E322-E329.
45. 楊漢立, 鐘遠鳴, 何啟斌, 等. 納米羥基磷灰石與聚醚醚酮椎間融合器的比較. 中國矯形外科雜志, 2022, 30(16): 1473-1477.
46. 王彥金, 周英杰, 柴旭斌, 等. 3D打印多孔鈦合金椎間融合器與聚醚醚酮椎間融合器在后路腰椎椎間融合術中的應用研究. 中國修復重建外科雜志, 2022, 36(9): 1126-1131.

Chinese Journal of Reparative and Reconstructive Surgery

Research progress on the influence of Modic changes on lumbar interbody fusion and its treatment measure

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