Our Summary

This research paper reviews the effects of Modic changes on lumbar interbody fusion, which is a surgical procedure to join two or more lower back vertebrae into one solid bone. Modic changes refer to changes in the bones of the spine visible on MRI scans, often associated with back pain. The exact cause of Modic changes is still not clear, but it could be due to mechanical factors, immunity issues, low-level infections, or genetic factors.

Modic changes can cause problems with lumbar interbody fusion, including fusion failure and cage subsidence, which means the surgical implant (cage) used to replace the disc space sinks into the vertebrae.

The paper suggests that a careful preoperative evaluation, including assessment of endplate sclerosis (hardening of the endplate of the vertebrae), reducing injury to the endplate during surgery, careful management of the space between the vertebrae, managing osteoporosis, and choosing the right cage for the surgery, can help prevent or reduce these complications.

In conclusion, taking active steps to manage Modic changes before and after lumbar interbody fusion surgery can help improve the outcome for the patient.

FAQs

  1. What are Modic changes and how do they influence lumbar interbody fusion?
  2. What factors could potentially cause Modic changes?
  3. What are the potential ways to prevent or reduce fusion failure or cage subsidence after lumbar interbody fusion?

Doctor’s Tip

A helpful tip a doctor might tell a patient about lumbar fusion is to make sure to follow all preoperative instructions carefully, including managing osteoporosis if necessary, as this can help prevent fusion failure or cage subsidence. Additionally, it is important to discuss any concerns or questions with your healthcare provider before undergoing the procedure.

Suitable For

Patients who are typically recommended lumbar fusion are those who have severe and persistent low back pain, instability of the spine, degenerative disc disease, spondylolisthesis, spinal stenosis, scoliosis, or other spinal deformities. These patients may have tried conservative treatments such as physical therapy, medication, and injections without success, and their symptoms are significantly affecting their quality of life and daily activities. Lumbar fusion may be recommended by a spine surgeon after a thorough evaluation of the patient’s medical history, physical examination, imaging studies, and response to previous treatments. Patients with Modic changes in the lumbar spine may also be considered for lumbar fusion surgery if the changes are causing fusion failure or cage subsidence.

Timeline

Before lumbar fusion:

  1. Patient experiences chronic low back pain, leg pain, and/or numbness due to conditions such as degenerative disc disease, spinal stenosis, or spondylolisthesis.
  2. Patient undergoes imaging studies such as X-rays, MRI, or CT scans to assess the severity of the spinal condition and determine the need for surgery.
  3. Patient may undergo conservative treatments such as physical therapy, medications, injections, and lifestyle modifications to manage symptoms before considering surgery.

After lumbar fusion:

  1. Patient undergoes surgery to stabilize the spine and alleviate symptoms, such as spinal fusion with the placement of hardware such as screws, rods, and cages.
  2. Patient may experience postoperative pain, swelling, and restrictions in mobility immediately after surgery.
  3. Patient undergoes postoperative rehabilitation, including physical therapy, to regain strength and function in the spine.
  4. Patient gradually resumes normal activities and experiences improvement in symptoms over time, with the goal of achieving a successful fusion and long-term pain relief.

What to Ask Your Doctor

Some questions a patient should ask their doctor about lumbar fusion and Modic changes include:

  1. What are Modic changes and how do they affect lumbar interbody fusion?
  2. What are the potential risks and complications associated with Modic changes during lumbar fusion surgery?
  3. How will you evaluate and address Modic changes in my specific case before proceeding with fusion surgery?
  4. What measures will be taken during surgery to prevent fusion failure or cage subsidence related to Modic changes?
  5. How will you manage any existing osteoporosis or other factors that may impact the success of the fusion surgery?
  6. Are there any specific post-operative care instructions or follow-up appointments I should be aware of regarding Modic changes and fusion surgery?
  7. What is the expected recovery timeline and prognosis for someone with Modic changes undergoing lumbar fusion surgery?

Reference

Authors: Xiao Y, Yang X. Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Aug 15;37(8):1026-1030. doi: 10.7507/1002-1892.202302007. PMID: 37586805