1
|
Huneidi M, Jankowski PP, Bouyer B, Damade C, Vital JM, Gille O, Boissière L. Contribution of MRI and imaging exams in the diagnosis of lumbar pseudarthrosis. Orthop Traumatol Surg Res 2024:103817. [PMID: 38246489 DOI: 10.1016/j.otsr.2024.103817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 10/25/2023] [Accepted: 01/16/2024] [Indexed: 01/23/2024]
Abstract
INTRODUCTION The diagnosis of pseudoarthrosis is based on imaging and clinical exam findings. The standard for pseudarthrosis diagnosis remains postoperative observation through computer tomography (CT) and patient's symptoms. This can be further augmented by dynamic X-ray imaging or nuclear positron emission tomography (PET) CT to demonstrate an absence of fusion by showing a persistence of mobility. However, there is not a uniform diagnostic approach that is a standard of care amongst spine practioners. The aim of this study is to describe the timeline and diagnostic analysis for pseudoarthrosis between the initial surgery and follow-up procedure. METHODS This is a single-center retrospective observational study. The aim was to enroll patients reoperated for pseudarthrosis after 1 or 2 level lumbar fusions, between August 1st, 2008 and August 1st, 2018. The exams were reviewed by one surgeon and one radiologist, defining a status either in favor of pseudarthrosis, or against it, or inconclusive, based on the radiological criteria mentioned below. We then investigated different combinations of exams and their specific chronology before a diagnosis was established. RESULTS Forty-four patients were included, 70.5% male and with a mean age of 47.3 years. The median time between the 2 surgeries was 23.7 months. Plain X-rays supported the diagnosis in 38.7% of cases, dynamic X-rays showed hypermobility in 50% of cases. The CT-scan demonstrated pseudarthrosis in 94,4% of cases. A MODIC 1 signal was observed in 87,2% of cases on MRI. SPECT-CT showed a tracer uptake in 70% of cases. CONCLUSION Reducing the time to reintervention is a key objective for improving the management and clinical outcomes of these patients. We suggest that MRI is an additional tool in combination with CT in the assessment of suspected mechanical pseudarthrosis, in order to optimize the diagnosis and shorten the time to revision surgery. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Maxime Huneidi
- Department of Orthopaedic Surgery, University Hospital of Bordeaux, Spinal Unit, Bordeaux, France.
| | | | - Benjamin Bouyer
- Department of Orthopaedic Surgery, University Hospital of Bordeaux, Spinal Unit, Bordeaux, France
| | - Camille Damade
- Department of Orthopaedic Surgery, University Hospital of Bordeaux, Spinal Unit, Bordeaux, France
| | - Jean-Marc Vital
- Department of Orthopaedic Surgery, University Hospital of Bordeaux, Spinal Unit, Bordeaux, France
| | - Olivier Gille
- Department of Orthopaedic Surgery, University Hospital of Bordeaux, Spinal Unit, Bordeaux, France
| | - Louis Boissière
- Department of Orthopaedic Surgery, University Hospital of Bordeaux, Spinal Unit, Bordeaux, France
| |
Collapse
|
2
|
The relationship between traction spurs, Modic change, vacuum phenomenon, and segmental instability of the lumbar spine. Sci Rep 2022; 12:9939. [PMID: 35705718 PMCID: PMC9200777 DOI: 10.1038/s41598-022-14244-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/03/2022] [Indexed: 12/04/2022] Open
Abstract
A thorough understanding of lumbar segmental motion is valuable to treat patients with degenerative lumbar disease, but kinematics associated with indicators of lumbar intervertebral instability [traction spur, Modic changes (MCs) and vacuum phenomenon (VP)] in the lumbar spine have not been well understood. The purpose of this study is to evaluate the relationships between traction spur, MCs and VP to radiographic measurements in the lumbar spine. A total of 525 lumbar discs from L1-2 to L5-S1 of 105 patients were evaluated. The sagittal translation (ST) and sagittal angulation were measured from the radiographs taken flexion–extension. The anterior disc height (ADH) was measured from the lateral radiographs, and ΔADH was measured as the difference from supine to sitting position. Logistic regression analyses were used to detect the association between the existence of traction spur, MCs and VP and related factors. Multivariate analysis showed that the traction spur was significantly related to translational motion (ST > 2 mm, OR 4.74) and the VP was significantly related to vertical motion (ΔADH > 3 mm, OR 1.94). These results suggest that the segments with traction spur and VP should be evaluated carefully because these may be a sign of lumbar intervertebral instability.
Collapse
|
3
|
Applebaum A, Nessim A, Cho W. Modic Change: An Emerging Complication in the Aging Population. Clin Spine Surg 2022; 35:12-17. [PMID: 33769981 DOI: 10.1097/bsd.0000000000001168] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 02/24/2021] [Indexed: 01/04/2023]
Abstract
STUDY DESIGN This was a literature review. OBJECTIVE The objective of this study was to review the pathogenesis, prevalence, clinical associations, diagnostic modalities, and treatment options for patients with lower back pain (LBP) associated with Modic change (MC). SUMMARY OF BACKGROUND DATA Vertebral body endplates are located between the intervertebral disk and adjacent vertebral body. Despite their crucial roles in nutrition and biomechanical stability, vertebral endplates are extremely susceptible to mechanical failure. Studies examining the events leading to disk degeneration have shown that failure often begins at the endplates. Endplate degeneration with subchondral bone marrow changes were originally noticed on magnetic resonance imaging. These magnetic resonance imaging signal changes were classified as MC. METHODS A literature review was conducted on the history, etiology, risk factors, diagnostic modalities, and treatment of LBP with MC. RESULTS Type 1 MC refers to the presence of increased vascularization and bone marrow edema within the vertebral body. Type 2 MC involves fatty marrow replacement within the vertebral body. Type 3 MC reflects subchondral bone sclerosis. Despite the original classification, research has supported the notion that MCs possess a transitional nature. Furthermore, type 1 MCs have been strongly associated with inflammation and severe LBP, while types 2 and 3 tend to be more stable and demonstrate less refractory pain. With a strong association to LBP, understanding the etiology of MC is crucial to optimal treatment planning. Various etiologic theories have been proposed including autoimmunity, mechanics, infection, and genetic factors. CONCLUSIONS With the aging nature of the population, MC has emerged as an extremely prevalent issue. Research into the pathogenesis of MC is important for planning preventative and therapeutic strategies. Such strategies may include rehabilitation, surgical fixation, stabilization, steroid or cement injection, or antibiotics. Improved diagnostic methods in clinical practice are thus critical to properly identify patients suffering from MC, plan early intervention, and hasten return to functioning.
Collapse
Affiliation(s)
- Ariella Applebaum
- Department of Orthopedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | | | | |
Collapse
|
4
|
Baker JD, Sayari AJ, Harada GK, Tao Y, Louie PK, Basques BA, Galbusera F, Niemeyer F, Wilke HJ, An HS, Samartzis D. The Modic-endplate-complex phenotype in cervical spine patients: Association with symptoms and outcomes. J Orthop Res 2022; 40:449-459. [PMID: 33749924 DOI: 10.1002/jor.25042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 02/04/2023]
Abstract
This study describes a novel, combined Modic changes (MC) and structural endplate abnormality phenotype of the cervical spine, which we have termed the Modic-Endplate-Complex (MEC), and its association with preoperative symptoms and outcomes in anterior cervical discectomy and fusion (ACDF) patients. This was a retrospective study of prospectively collected data at a single institution. Preoperative cervical magnetic resonance imagings were used to assess the presence of MC and endplate abnormalities. Patients were divided into four groups: MC-only, endplate abnormality-only, the MEC and controls. The MEC was defined as the presence of both a MC and endplate abnormality in the cervical spine. Phenotypes were further stratified by location and compared to controls. Associations with patient-reported outcome measures were assessed using regression controlling for baseline characteristics. A total of 628 patients were included, with 84 MC-only, 166 endplate abnormality-only, and 187 MEC patients. Both MC (p < 0.001) and endplate abnormalities (p < 0.001) were independently associated with one another. MC at the adjacent level (p = 0.018), endplate abnormalities (regardless of location) (p = 0.001), and the MEC within the fusion segment (p = 0.027) were all associated with higher Neck Disability Index scores. Both MC within the fusion segment (p = 0.008) and endplate abnormalities within the fusion segment (p = 0.017) associated with lower Veteran's Rand 12-item scores. MC and structural endplate abnormalities commonly manifest concomitantly in patients indicated for ACDF for degenerative pathology. Patients with the endplate pathology, including the MEC phenotype, reported significantly higher levels of postoperative disability following ACDF. These findings add valuable data to the prognostic assessment of degenerative cervical spine patients.
Collapse
Affiliation(s)
- James D Baker
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois, USA
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois, USA
| | - Garrett K Harada
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois, USA
| | - Youping Tao
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Philip K Louie
- Department of Neurosurgery, Neuroscience Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois, USA
| | - Fabio Galbusera
- Department of Orthopaedic Surgery, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Frank Niemeyer
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois, USA
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
5
|
Udby PM, Ohrt-Nissen S, Bendix T, Brorson S, Carreon LY, Andersen MØ. The Association of MRI Findings and Long-Term Disability in Patients With Chronic Low Back Pain. Global Spine J 2021; 11:633-639. [PMID: 32875907 PMCID: PMC8165932 DOI: 10.1177/2192568220921391] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Longitudinal cohort study with 13-year follow-up. OBJECTIVE To assess whether long-term disability is associated with baseline degenerative magnetic resonance imaging (MRI) findings in patients with low back pain (LBP). METHODS In 2004-2005, patients aged 18 to 60 years with chronic LBP were enrolled in a randomized controlled trial and lumbar MRI was performed. Patients completed the Roland-Morris Disability Questionnaire (RMDQ) and the LBP Rating Scale, at baseline and 13 years after the MRI. Multivariate regression analysis was performed with 13-year RMDQ as the dependent variable and baseline disc degeneration (DD, Pfirrmann grade), Modic changes (MC), facet joint degeneration (FJD, Fujiwara grade) smoking status, body mass index, and self-reported weekly physical activity at leisure as independent variables. RESULTS Of 204 patients with baseline MRI, 170 (83%) were available for follow-up. Of these, 88 had Pfirrmann grade >III (52%), 67 had MC (39%) and 139 had Fujiwara grade >2 (82%) on at least 1 lumbar level. Only MC (β = -0.15, P = .031) and weekly physical activity at leisure (β = -0.51, P < .001) were significantly, negatively, associated with 13-year RMDQ-score (R2 = 0.31). CONCLUSION DD and FJD were not associated with long-term disability. Baseline MC and weekly physical activity at leisure were statistically significantly associated with less long-term disability.
Collapse
Affiliation(s)
- Peter Muhareb Udby
- Zealand University Hospital, Køge, Denmark,Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,Spine Center of Southern Denmark, part of Lillebaelt Hospital, Middelfart, Denmark,Peter Muhareb Udby, Spine Unit, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark.
| | | | - Tom Bendix
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Leah Y. Carreon
- Spine Center of Southern Denmark, part of Lillebaelt Hospital, Middelfart, Denmark
| | | |
Collapse
|
6
|
Li J, Zhang J, Tong T, Shen Y. Influence of Modic Changes on Cage Subsidence and Intervertebral Fusion after Single-Level Anterior Cervical Corpectomy and Fusion. J INVEST SURG 2020; 35:301-307. [PMID: 33283538 DOI: 10.1080/08941939.2020.1855487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This retrospective study aimed to determine the impact of Modic changes (MCs) on cage subsidence (CS) and intervertebral fusion after anterior cervical corpectomy and fusion (ACCF). METHODS This study enrolled 61 patients with MCs who underwent single-level ACCF between January 2010 and December 2015 at our institution. The control group included 63 age-matched patients without MCs treated during the same period. The results from clinical and radiological assessments were reviewed, and radiographic CS was defined by an intervertebral height at the final follow-up that was less than the postoperative intervertebral height. RESULTS No significant differences in gender, age, operative time, blood loss, or follow-up results were observed between the MCs and control groups. Significantly more patients experienced CS in the MCs group than in the control group (41.0% vs. 15.9%; p = 0.003). The frequencies of CS among patients with type I MCs (40.0%, 8/20) and type II MCs (41.5%, 17/41) were significantly higher than that in the control group (15.9%, 10/63; p < 0.05). Both groups showed significant improvements in clinical assessment scores after surgery and at final follow-up compared with preoperative values (p < 0.05). CONCLUSION In summary, all 61 patients with MCs who underwent ACCF achieved good fusion results. MCs in the surgical segment had no significant effect on intervertebral fusion, but both type 1 and type 2 MCs may increase the risk of CS.
Collapse
Affiliation(s)
- Jia Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jingtao Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tong Tong
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yong Shen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
7
|
Baker JD, Harada GK, Tao Y, Louie PK, Basques BA, Galbusera F, Niemeyer F, Wilke HJ, An HS, Samartzis D. The Impact of Modic Changes on Preoperative Symptoms and Clinical Outcomes in Anterior Cervical Discectomy and Fusion Patients. Neurospine 2020; 17:190-203. [PMID: 32252168 PMCID: PMC7136113 DOI: 10.14245/ns.2040062.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/16/2020] [Indexed: 12/16/2022] Open
Abstract
Objective To assess the impact of Modic changes (MC) on preoperative symptoms, and postoperative outcomes in anterior cervical discectomy and fusion (ACDF) patients.
Methods We performed a retrospective study of prospectively collected data of ACDF patients at a single institution. Preoperative magnetic resonance imagings were used to assess the presence of MC. MC were stratified by type and location, and compared to patients without MC. Associations with symptoms, patient-reported measures, and surgical outcomes were assessed.
Results A total of 861 patients were included, with 356 patients with MC (41.3%). MC more frequently occurred at C5–6 (15.1%), and type II was the most common type (61.2%). MC were associated with advanced age (p < 0.001), more levels fused (p < 0.001), a longer duration of symptoms, but not with specific symptoms. MC at C7–T1 resulted in higher postoperative disability (p < 0.001), but did not increase risk of adjacent segment degeneration or reoperation.
Conclusion This study is the first to systematically examine the impact of cervical MC, stratified by type and location, on outcomes in ACDF patients. Patients with MC were generally older, required larger fusions, and had longer duration of preoperative symptoms. While MC may not affect specific outcomes following ACDF, they may indicate a more debilitating preoperative state for patients.
Collapse
Affiliation(s)
- James D Baker
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, IL, USA
| | - Garrett K Harada
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, IL, USA
| | - Youping Tao
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Philip K Louie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, IL, USA
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, IL, USA
| | | | - Frank Niemeyer
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, IL, USA
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative (ISRII), Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
8
|
Modic Changes Are Not Associated With Long-term Pain and Disability: A Cohort Study With 13-year Follow-up. Spine (Phila Pa 1976) 2019; 44:1186-1192. [PMID: 30985571 DOI: 10.1097/brs.0000000000003051] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A comparative cohort study with 13-year follow-up. OBJECTIVE To assess whether Modic changes (MCs) are associated with long-term physical disability, back pain, and sick leave. SUMMARY OF BACKGROUND DATA Previous studies have shown a conflicting association of low back pain (LBP) with MCs and disc degeneration. The long-term prognosis of patients with MCs is unclear. METHODS In 2004 to 2005, patients aged 18 to 60 with daily LBP were enrolled in an randomized controlled trial study and lumbar magnetic resonance imaging (MRI) was performed. Patients completed numeric rating scales (0-10) for LBP and leg pain, Roland-Morris Disability Questionnaire (RMDQ), LBP Rating Scale for activity limitations (RS, 0-30), inflammatory pain pattern and sick leave days due to LBP at baseline and 13 years after the MRI. Patients were stratified based on the presence (+MC) or absence (-MC) of MCs on the MRI. RESULTS Of 204 cases with baseline MRI, 170 (83%) were available for follow-up; 67 (39%) with MCs and 103 (61%) without MCs. Demographics, smoking status, BMI, use of antibiotics, LBP, leg pain, and inflammatory pain pattern scores at baseline and at 13-year follow-up were similar between the two groups. Also, baseline RMDQ was similar between the +MC and -MC groups. At 13 years, the RMDQ score was statistically significant better in the +MC group (7.4) compared with the -MC group (9.6, P = 0.024). Sick leave days due to LBP were similar at baseline but less in the +MC group (9.0) compared with the -MC group (22.9 d, P = 0.003) at 13 years. CONCLUSION MCs were not found to be negatively associated with long-term pain, disability, or sick leave. Rather, the study found that LBP patients with MCs had significantly less disability and sick-leave at long-term follow-up. We encourage further studies to elucidate these findings. LEVEL OF EVIDENCE 2.
Collapse
|