Our Summary

This research paper is a thorough review and analysis of various studies on patients with lumbar disc herniation (LDH), a condition where a disc in the spine ruptures or becomes damaged, causing back pain. Some of these patients have preoperative Modic changes (MC), which are specific types of bone changes seen on an MRI.

The researchers were interested in how these Modic changes might affect patients’ pain and ability to function after they have surgery (discectomy) to treat the LDH. They looked at various studies that had been conducted, including both retrospective studies (looking back at past data) and prospective studies (following patients into the future).

The results showed that, overall, patients with or without these Modic changes experienced similar levels of pain relief and improvement in function one and two years after surgery. However, patients with a specific type of Modic change (type 1) had worse functional outcomes two years after surgery compared to those with no changes or a different type of change (type 2). This means they had more difficulty with activities like walking, bending, and lifting.

However, the researchers emphasize that these results are not definitive, as the studies they looked at varied in their methods and quality, and there is a need for more high-quality, carefully controlled research to fully understand the impact of these Modic changes on patients’ recovery from LDH surgery.

FAQs

  1. What are Modic changes and how do they relate to lumbar disc herniation?
  2. Does the presence of Modic changes affect the outcome of discectomy surgery for patients with lumbar disc herniation?
  3. What is the difference in post-surgery functional outcomes between patients with type 1 Modic changes and those with type 2 or no Modic changes?

Doctor’s Tip

Based on this information, a doctor might tell a patient considering discectomy the following tip:

“It is important to discuss any Modic changes seen on your MRI with your surgeon before undergoing discectomy. While most patients experience similar levels of pain relief and function improvement after surgery, those with type 1 Modic changes may have a slower recovery. It is important to manage your expectations and work closely with your healthcare team to ensure the best possible outcome.”

Suitable For

Overall, patients with lumbar disc herniation are typically recommended for discectomy if they have persistent and severe back pain and/or leg pain that has not responded to conservative treatments such as physical therapy, medications, and injections. In some cases, patients may also have neurological symptoms such as weakness, numbness, or tingling in the legs, which can indicate nerve compression.

It is important for patients to undergo a thorough evaluation by a spine specialist to determine if they are a good candidate for discectomy. Factors that may impact the decision to recommend surgery include the location and size of the herniated disc, the severity of symptoms, the patient’s overall health and medical history, and their preferences and goals for treatment.

Patients with certain risk factors, such as obesity, smoking, or underlying medical conditions, may be at higher risk for complications from surgery and may need to address these factors before undergoing discectomy. Additionally, patients with certain spinal conditions or abnormalities, such as spinal instability or spinal stenosis, may require a different type of surgery or additional procedures in conjunction with discectomy.

Overall, the decision to recommend discectomy for patients with lumbar disc herniation is based on a careful assessment of the individual patient’s condition and needs, with the goal of relieving pain, improving function, and optimizing long-term outcomes.

Timeline

Overall, the timeline of a patient’s experience before and after discectomy for LDH might look like this:

Before surgery:

  1. Patient experiences back pain, leg pain, and/or numbness
  2. Patient undergoes diagnostic tests such as MRI to confirm LDH
  3. Patients may have Modic changes seen on MRI
  4. Patient and healthcare team discuss treatment options, including surgery

After surgery:

  1. Patient undergoes discectomy surgery to remove the damaged disc
  2. Patient goes through a recovery period, which may include physical therapy and pain management
  3. Patient experiences some immediate pain relief post-surgery
  4. Patient gradually improves in function and experiences reduced pain over time
  5. Patients with Modic changes may have different outcomes compared to those without, with some experiencing more difficulty with functional activities
  6. Long-term follow-up is needed to assess the success of surgery and the impact of Modic changes on recovery

Overall, the timeline of a patient’s experience before and after discectomy for LDH involves a thorough evaluation, surgical intervention, and ongoing recovery and follow-up to monitor outcomes.

What to Ask Your Doctor

Some questions a patient should ask their doctor about discectomy in relation to Modic changes include:

  1. How do Modic changes in my spine affect my likelihood of experiencing pain after discectomy surgery?
  2. Are there specific types of Modic changes that may impact my recovery differently?
  3. What are the potential risks or complications associated with discectomy surgery in the presence of Modic changes?
  4. How will you determine if Modic changes are present in my spine before recommending surgery?
  5. What alternative treatments or therapies may be considered for managing pain associated with Modic changes?
  6. What is the likelihood of needing additional surgery or treatments in the future if Modic changes are present?
  7. Can you provide information on the success rates of discectomy surgery for patients with Modic changes compared to those without?
  8. Are there any lifestyle changes or rehabilitation exercises that may help improve outcomes for patients with Modic changes undergoing discectomy surgery?
  9. How will you monitor my progress and pain levels post-surgery if Modic changes are present?
  10. Are there any specific precautions or considerations I should be aware of during the recovery period if Modic changes are present in my spine?

Reference

Authors: Nian S, Li N, Kong F, Lu S, Chen J. Journal: Spine J. 2023 Apr;23(4):533-549. doi: 10.1016/j.spinee.2022.10.008. Epub 2022 Oct 31. PMID: 36328303