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.	唐少龙, 叶招明, 黄庆华, 等. 腰椎终板Modic改变与腰椎退变的相关性研究. 临床骨科杂志, 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.	何江涛, 何姝, 付能高, 等. 单侧内固定椎间融合术治疗伴Modic改变的腰椎间盘突出症早期疗效. 临床骨科杂志, 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.	Özcan-Ekşi EE, Yayla A, Orhun Ö, 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, Määttä 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.	Hanımoğlu H, Çevik S, Yılmaz 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.	周兴, 陆艳青, 彭建平, 等. TNF-α对人骨髓间充质干细胞sncRNAs表达的调控研究. 中国临床新医学, 2022, 15(5): 388-394.
29.	马辉. Modic改变对退行性腰椎间盘疾病后路融合手术疗效影响的分析. 广州: 广州中医药大学, 2015.
30.	王牧一, 徐亮, 邱勇, 等. Modic改变对腰椎经椎间孔椎间融合效果和融合器沉降的影响. 中华医学杂志, 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, 孙崇毅. 椎间融合术后Modic改变对预后的影响及其预防与治疗研究进展. 脊柱外科杂志, 2021, 19(6): 424-427.
38.	禹名卉, 赵彦涛, 衷鸿宾, 等. 骨形态发生蛋白2在腰椎融合术中应用的效果与并发症. 中国骨与关节杂志, 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.	吴楠. Modic改变与骨质疏松及下腰痛相关性分析. 蚌埠: 蚌埠医学院, 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.	赵龙, 曾建成, 谢天航, 等. 腰椎椎间融合术后椎间融合器沉降的研究进展. 中国修复重建外科杂志, 2021, 35(8): 1063-1067.
43.	杨曦, 宋跃明, 孔清泉, 等. 纳米羟基磷灰石/聚酰胺66椎间融合器植骨融合治疗下腰椎退变性疾病的近期疗效. 中国修复重建外科杂志, 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.	杨汉立, 钟远鸣, 何启斌, 等. 纳米羟基磷灰石与聚醚醚酮椎间融合器的比较. 中国矫形外科杂志, 2022, 30(16): 1473-1477.
46.	王彦金, 周英杰, 柴旭斌, 等. 3D打印多孔钛合金椎间融合器与聚醚醚酮椎间融合器在后路腰椎椎间融合术中的应用研究. 中国修复重建外科杂志, 2022, 36(9): 1126-1131.

1. 唐少龙, 叶招明, 黄庆华, 等. 腰椎终板Modic改变与腰椎退变的相关性研究. 临床骨科杂志, 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. 何江涛, 何姝, 付能高, 等. 单侧内固定椎间融合术治疗伴Modic改变的腰椎间盘突出症早期疗效. 临床骨科杂志, 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. Özcan-Ekşi EE, Yayla A, Orhun Ö, 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, Määttä 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. Hanımoğlu H, Çevik S, Yılmaz 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. 周兴, 陆艳青, 彭建平, 等. TNF-α对人骨髓间充质干细胞sncRNAs表达的调控研究. 中国临床新医学, 2022, 15(5): 388-394.
29. 马辉. Modic改变对退行性腰椎间盘疾病后路融合手术疗效影响的分析. 广州: 广州中医药大学, 2015.
30. 王牧一, 徐亮, 邱勇, 等. Modic改变对腰椎经椎间孔椎间融合效果和融合器沉降的影响. 中华医学杂志, 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, 孙崇毅. 椎间融合术后Modic改变对预后的影响及其预防与治疗研究进展. 脊柱外科杂志, 2021, 19(6): 424-427.
38. 禹名卉, 赵彦涛, 衷鸿宾, 等. 骨形态发生蛋白2在腰椎融合术中应用的效果与并发症. 中国骨与关节杂志, 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. 吴楠. Modic改变与骨质疏松及下腰痛相关性分析. 蚌埠: 蚌埠医学院, 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. 赵龙, 曾建成, 谢天航, 等. 腰椎椎间融合术后椎间融合器沉降的研究进展. 中国修复重建外科杂志, 2021, 35(8): 1063-1067.
43. 杨曦, 宋跃明, 孔清泉, 等. 纳米羟基磷灰石/聚酰胺66椎间融合器植骨融合治疗下腰椎退变性疾病的近期疗效. 中国修复重建外科杂志, 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. 杨汉立, 钟远鸣, 何启斌, 等. 纳米羟基磷灰石与聚醚醚酮椎间融合器的比较. 中国矫形外科杂志, 2022, 30(16): 1473-1477.
46. 王彦金, 周英杰, 柴旭斌, 等. 3D打印多孔钛合金椎间融合器与聚醚醚酮椎间融合器在后路腰椎椎间融合术中的应用研究. 中国修复重建外科杂志, 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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